Frustrating hot flashes? Meddlesome mood swings? Challenging body changes?
Women often struggle with physical and emotional symptoms when transitioning into menopause. Hormone therapy can provide relief for difficult menopausal symptoms, but it isn't without risks.
If you are considering hormone therapy, here are some of the key points that you need to know in order to use hormone therapy safely and effectively according to The North American Menopause Society:
• Most of the data cited regarding hormone therapy has been drawn from the Women’s Health Initiative (WHI), which is the only large, long-term randomized control trial in which women were given hormones for 5-7 years. The long term use of hormone therapy greater than 7 years has yet to be thoroughly investigated.
• The FDA has approved hormone therapy for the following menopausal conditions: hot flashes and night sweats, prevention of bone loss in women who are at high risk of developing osteoporosis and fractures, women with early onset menopause (< 45 years of age) and genitourinary symptoms (vaginal dryness and atrophy, recurrent urinary tract infections and pain with intercourse).
• Hormone therapy should be individualized, taking into account the type of hormone therapy, dose, regimen, indications, the woman’s age and time since menopause, the woman’s health risks, family history and personal preferences.
• For women who start hormone therapy more than 10 years after menopause or are aged 60 and older on hormone therapy, there is an increased risk of coronary heart disease, stroke, blood clots and dementia.
• Women with a uterus should not be prescribed systemic estrogen without the use of progesterone, as there is a significant increased risk of developing uterine cancer.
• Vaginal routes of low dose estrogen for vaginal symptoms do not carry the increased risk of developing uterine cancer and can be initiated at any age. It is also important to note that vaginal menopausal changes generally worsen with time.
• Systemic hormone therapy is contraindicated in women with unexplained vaginal bleeding, liver disease, history of breast or uterine cancer, heart disease, stroke, dementia and blood clotting disorders.
• Women who are younger than 60 or who are within 10 years of menopause have a rare risk of breast cancer (< 1 additional case/1,000 person-years of use) with combined estrogen and progesterone therapy. Smaller hormone studies apart from the WHI have not been shown to demonstrate an increased breast cancer risk.
• The data are inconsistent, but if an association between hormone therapy and ovarian cancer exists, the absolute risk is likely to be rare (< 1/1000) or very rare (< 0.01/1000) and more likely with longer durations of hormone use.
• Hormone therapy may help with belly fat and the weight gains that are often associated with menopause, but this was found to be effective only during the first year of initiating hormone therapy.
As a naturopathic doctor, I recognize the body’s ability to process and metabolize hormones and understand the importance of supporting liver and colon function to eliminate hormones effectively through their detoxification pathways.
Before starting hormone therapy and for hormone refills, it is crucial for women to have an up-to-date pelvic and pap exam, mammogram and blood work.
For women who do not desire hormone therapy or for whom hormone therapy is contraindicated, there are a variety of other approaches for managing the symptoms of menopause, such as herbal and nutritional supplements and lifestyle modification.
Navigating the research of hormone therapy is dense and can be contradictory at times. For most cases, it makes sense to use the lowest doses of hormones for the shortest period of time, to appropriately screen and educate patients about the risks and side effects of hormone therapy before initiating treatment, and to be sure that your body is effectively processing all your hormones as well as the ones you may choose to take after menopause.