Several years ago a study called the Women’s Health Initiative (WHI) said that hormone therapy should be used cautiously due to increase risk of breast cancer, heart attack and stroke. This caused quite a firestorm and menopause really hasn’t been the same since. And as I write this, the U.S. Preventive Services Task Force has just issued a recommendation against using hormones for women for any chronic disesease prevention. That organization asserts that only young, newly menopausal women with symptoms should be treated with low dose for the shortest amount of time.
So what is the answer?
Hormone therapy remains the most effective treatment for vasomotor symptoms—that is, hot flashes. Eating gobs of soy or black cohosh has not proven to be helpful with hot flashes. These treatments are no more effective than taking a sugar pill. Some medications, like anti-depressants, have proven useful although they aren’t intended for treating hot flashes.
Finding what works
I think you deserve an individualized approach to a plan for menopause. Remember, the symptoms may start in your mid 40s and last until your late 50s. If your symptoms are affecting activities of daily living, then you need to discuss hormones with your healthcare provider.
Since the WHI study, a lot of new and interesting data has come out. Hormones are not nearly as risky as the study seemed to indicate, and they may be a great option for a lot of women. Healthy, newly menopausal women are excellent candidates for hormones. And new lower-dose formulations of estrogen and progesterone reduce risks and side effects, too. The American College of Obstetricians and Gynecologists recommends that you use the lowest effective dose for the shortest period of time.
A recent U.S. study found that the average number of years that women complained of moderate to severe hot flashes was 10.2 years. That’s a lot of years to be hot! I’m thinking my husband would not stand for being that uncomfortable for more than about one day!
Most menopausal women who come to my office complain of no sleep, hot flashes (mostly at night) and moodiness. These are bothersome symptoms that affect daily life. Lack of sleep is really problematic for many women—you can’t get anything done if you’re pooped!
Running through your choices
Estrogen is a great answer for hot flashes. It comes in pills, patches and creams. New evidence that using an estrogen patch may reduce your risk of blood clots since this delivery system does not go through the liver, which produces blood-clotting enzymes.
If you have a uterus, you also need to take progesterone to protect the lining of your uterus from unopposed estrogen. (You have some risk of uterine cancer if you do not use the progesterone in conjunction with estrogen.) Progesterone will help you sleep. (Yay!)
Progesterone comes in various forms. I prefer to use a “micronized progesterone” like Prometrium. These formulations are easier to absorb.
The North American Menopause Society has a new position statement that I think is worth paying attention to. Basically it says that if you have had a hysterectomy, using estrogen only will help with hot flashes and prevent osteoporosis. The benefit/risk ratio is lower since you are using only estrogen, and you may be able to stay on estrogen for a longer period of time.
If you have a uterus and have hot flashes you can use combination hormone therapy—estrogen and progestin—but for a shorter amount of time (usually three to five years) due to the increased risk of invasive breast cancer. It is not completely clear whether the progestin has a part in the increased risk of breast cancer.
What about bioidentical hormones?
Are bioidentical hormones—those that are identical in molecular structure to the hormones your body produces—safer than the ones made by the drug companies?
I tell my patients that estrogen is estrogen. I counsel my patients the same way whether they are using bioidentical or synthetic hormone therapy. Bioidentical hormone therapy is not under the FDA regulation, although the elements that go into them have been FDA-approved. (They are mixed by compounding pharmacist rather than by drug companies.)
Ask me some questions; the answers are different for each woman. A complete health history is the starting point. I need to know your risk of heart disease, your lipids, your breast cancer risk and many other factors. When I know all of the above, and if you are considered healthy and low risk, then hormone therapy is a good option for you to help with the annoying symptoms of menopause.
If you breeze through menopause with no hot flashes, then you do not need any of the above. But I do want you exercising and taking calcium with vitamin D to protect your bones and your heart!
If you have questions about hormone therapy — or any other health concern — you can call 317-338-4-HER to talk to a registered nurse or use this form to talk to me directly.