At the Dr. Monica Christmas clinic these days, it sees two types of menopausal patients. The first, she said, suffers from the symptoms associated with this life phaseBut also beware of hormone therapy because she heard that health risks are associated with it.
The second type of patient is almost the exact opposite: she may not have symptoms at all, but nevertheless requires hormones because she heard that she would make her healthier.
“We seem to love these extremes,” said Dr. Christmas, director of the Menopause program and the Center for Women’s Integrated Health at the University of Chicago.
Prescription data reflect persistent anxiety around health risks: in a study Published in SeptemberResearchers found that only 5% of menopausal women used hormones in 2020 despite the fact that around 80% of women have symptoms.
On the other hand, in recent years, an increasing number of Social media influencers And celebrities, like Oprah Winfrey, strongly approved hormone therapy, presenting it as a “magic elixir”, said Dr. Christmas.
“Now there is this messaging that every woman who is menopausic should be under hormone therapy,” she said. But women need more clarity on what hormone therapy can and cannot do. “We must find our way to the common ground.”
What is menopausic hormone therapy?
Menopausic hormone therapy, or MHT, provides part of the estrogen and progesterone lost in menopause. Food and Drug Administration has approved dozens of types of therapies that have been showed to relieve A narrow set of symptoms, including vasomotor symptoms – such as heat puffs and night sweats – and Genito-Urinary syndromewhich refers to painful sex, vaginal dryness and urinary tract infections. Hormone therapy can also be used to prevent Menopausic loss of bone.
There are two main categories of hormonal treatment: systemic, in which hormones can affect the whole body, and local, which are applied just in the vagina. Systemic treatments contain either estrogens alone, or a combination of estrogen and progestins (a synthetic version of progesterone), and are in the form of a pill, a patch, a gel, a cream, a terminal or a vaginal ring. They attack heat puffs and night sweats and can prevent osteoporosis.
Systemic estrogens can in itself can cause thickening of uterine lining, which increases the risk of endometrial cancer, said Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health and Medical Director of the Menopause Society. Women who have removed their uterus can safely use estrogen, but others must also take a certain form of progestin to counter its effects.
Local treatments applied to the vagina are low -dose estrogens and are mainly intended to approach symptoms like vaginal dryness and pain with sex.
The MHT is not approved to treat dozens of other symptoms of menopause, such as depression, anxiety, jelly shoulder, weight gain or hair loss, said Dr. Makeba Williams, professor of obstetrics and gynecology at the Washington University School of Medicine in St. Louis. However, the menopause company, which establishes treatment guidelines, noted in its annual position statement that some patients who start hormone therapy also see small improvements in some of these symptoms.
Previous versions of hormone therapy approved by the FDA, which are still available today, contain what is called conjugated estrogen, derived from urine of pregnant horses, while products more commonly prescribed today (also approved by the FDA) have disputed what are called biointic estrogens, which come from plant sources and which creates a molecular structure more similar to the biioing hormones that the body creates. There is no quality studies comparing the hormones combined with head with bio-identical hormones, said Dr. Faubion, so we have no detailed understanding of the difficulty of their risks and their advantages.
Who is it?
According to the Society menopause, hormone therapy offers more effective relief and has less risks for a woman who suffers from vasomotor symptoms or genitarian syndrome and is under 60 or less than a decade Since their last period, compared to the one who started it later in life.
Hormone therapy is not recommended for women with a stroke of stroke, heart attacks, blood clots, liver disease, unexplained vaginal bleeding or estrogen -sensitive cancers, such as those in the breast or the uterus, as this could worsen these conditions.
What do we now know about the risks and advantages of hormone therapy?
The Landmark Women’s Health Initiative study, which was and is still the only major long -term randomized trial of hormone therapy, was interrupted prematurely in 2002 because researchers found that treatment raised risks for breast cancer and cardiovascular events. The study created a generalized panic that led to women abandon their treatments.
Since then, however, the researchers have reanalyzed the data, and the follow -up studies have found a more nuanced image: the dose, the delivery method and the age when therapy is initiated makes a big difference with the risks, said Dr. Makeba. And, in many cases, the advantages – including a Improved quality of life -May prevail over risks, she added.
Among symptomatic women under the age of 60, reanalyzed data have shown that out of 10,000 in 10,000 women using hormone therapy (specifically combined with estrogens and a progestogen pill), there were six additional cases of breast cancer, but not deaths related to breast cancer, and five additional coronary and stroke cases.
Meanwhile, hormone therapy has considerably reduced the risks of fractures, mortality of all causes and diabetes. For women taking only estrogen, studies have constantly found that hormone therapy reduced breast cancer And cardiovascular Risks – A discovery that is Still not fully understood.
Unrealized menopause symptoms have been linked to the long term Chronic health problems Later in life, including Neurodegenerative diseasesAlthough it is still not clear if the symptoms cause poor health or if they are markers of another underlying problem.
THE Menopause company warns that for women who start hormone therapy after 60 years, the risks For breast cancer and cardiovascular events, increase.
“If you read the package labeling, it will say” it can give you breast cancer, it can give you a heart attack “so there is this heritage of fear that still exists,” said Dr. Makeba. But “we must continue to educate on real risks, advantages and for whom hormone therapy is appropriate and not.”