Medical opinion has gone back and forth on the risks vs. benefits of using hormone therapy to ease the discomforts of menopause. The latest word is an emphatic “Yes” to hormone therapy. Here’s the full story.
SWEATING OUT MENOPAUSE
In former days, menopausal women were often treated with H.R.T., (Hormone Replacement Therapy) for such menopausal problems as hot flashes, sleep problems, mood disorders, and vaginal dryness and atrophy. The vaginal problems alone could be very serious, causing severe sexual discomfort, pain, bleeding, incontinence and urinary infections.
Some women with no menopausal issues also took H.R.T., because observational studies had led people to believe that it lowered the risk of osteoporosis, cardiovascular diseases, and some cancers.
A 2002 STUDY
The Women’s Health Initiative (W.H.I.) was a clinical trial of hormone replacement therapy and its impact on women in their 60s and 70s to see if it really did reduce the risk of heart disease. In fact, the results showed that those women treated with the hormones showed an increased risk of heart attacks, strokes, and blood clots. There was also a slightly higher risk of breast cancer for women who still had a uterus and therefore took both estrogen and progesterone (male hormone). (Note: women who had had their uterus removed and didn’t have to take progesterone, had no increase in breast cancer.)
These findings discouraged women from using (and doctors from recommending) H.R.T. for menopausal symptom relief.
W.H.I. FINDINGS RECONSIDERED
The big mistake researchers made, according to cardiologist, Dr. Howard N. Hodis, was to start the hormones in women already in their 60s and 70s—more than ten years past menopause and old enough to have already developed cardiovascular damage. Dr. Hodis claims that estrogen must be given within six years of menopause, before the onset of heart disease.
DANISH STUDY OF MENOPAUSAL WOMEN AND HORMONE TREATMENT
In a study of younger women just entering menopause, among those who were given hormones for 10 years, there was a reduction of both cardiovascular disease and breast cancer—“a clear benefit with nominal risk,” commented Dr. Hodis. These benefits persisted after 16 years of follow-up, according to the study which was published in 2012.
THE BOTTOM LINE
Women just entering menopause without a history of cancer, blood clots, or heart disease are now being recommended for hormone replacement treatment for up to five years. If they have no uterus and therefore take only estrogen, they can be treated even longer.
Today there are many options of hormone doses and ways to use them. There are pills, patches, sprays, and gels. Vaginal and urinary symptoms can be treated with vaginal inserts that don’t enter the blood stream, so even women who have had breast cancer can use them safely.
HELPING DOCTORS AND PATIENTS ASSESS OPTIONS
The North American Menopause Society has developed a mobile app, MenoPro, for iPhone/iPad and Android devices to allow every woman over 45, and her doctor, to select the best hormone treatment plan for her.
For more information:
• well.blogs.nytimes.com - Basic info for this article
• medscape.com - Dr. JoAnn Manson explains WHI results re: hormone therapy & menopause
• en.wikipedia.org - Dr. JoAnn E. Manson: A principal Investigator for The Women’s Health Initiative
• womensenews.org - Dr. Howard N. Hodis, cardiologist, on H.R.T. during menopause
• empowher.com - Dr. Howard N. Hodis: On women’s heart disease
• menopause.org - North American Menopause Society
• itunes.apple.com - Where to get MenoPro