Some women sail through menopause with little or no difficulty. For others, the cessation of menses and the accompanying wild hormone swings can be miserable.
Typical symptoms can include: thinning hair, dry skin, insomnia, vaginal dryness, night sweats, mood changes, weight gain due to slowing metabolism, loss of breast fullness, chills, and the dreaded hot flashes (a sudden feeling of heat throughout the body, but especially on the chest and face).
Menopause is diagnosed when menstrual periods have ceased completely for 12 full months. The average age in the U.S. for the onset of menopause is 51, but it can occur as early as age 40 or as late as the early 60s. It can also be triggered at any age by a hysterectomy if the ovaries are removed as part of the procedure.
Prior to the advent of modern medicine, women either endured the troublesome symptoms or turned to herbal supplements in an attempt to mitigate them. Beginning in 1943, however, the Wyeth Ayerst company began marketing a drug supplement, Premarin, derived from the urine of pregnant mares. Premarin replaced the estrogen that waned during menopause, helping many women alleviate their symptoms.
In the mid-1970s, however, the estrogen was supplemented in hormone replacement therapy (HRT) by progesterone or progestin due to an elevated risk of cancer shown to be higher for women who were receiving estrogen alone.
Medical science thought it had solved the problem of negative side effects by introducing this balance of the menopause-affected hormones. Many women, believing the drugs to be safe, took them indefinitely after menopause to not only alleviate menopause symptoms but to help retain their youthful appearance.
Until, that is, the Women’s Health Initiative (WHI), a long-term study of 160,000 post-menopausal women conducted by the National Institutes of Health (NHI) beginning in 1991, raised alarms throughout the medical community in 2002. The WHI seemed to show that HRT was quite the opposite of safe. It suggested that women who were receiving long-term HRT were at a higher risk of not only cancer but heart attacks and strokes.
Overnight women went off HRT and either suffered with their symptoms or turned to such alternatives as black cohosh, evening primrose oil, and other supplements, with varying degrees of success.
But, as with so much in medicine, your concierge family physicians at MD 2.0 in Jupiter, Florida, believe there is a happy—and safe—medium between the two extremes of unlimited and unending use of HRT and trying to suffer through menopause and its myriad distressing symptoms without it.
And more recent studies support this approach.
One study published last year in the Journal of the American Medical Association (JAMA), for example, examined the health records of more than 27,000 women who were given either HRT or a placebo, then followed for 18 years. Researchers found that women who received HRT were no more likely to die than those who took the sugar pills.
This supported another major study in 2015 in which New York University scientists found that women who took HRT for up to 25 years were no more likely than those who did not to develop heart disease, breast cancer, or diabetes.
A third, the Kronos Early Estrogen Prevention Study (KEEPS), found no significant association between hormone therapy and heart disease.
The key seems to be the timing of HRT. Starting the therapy within seven years of menopause confers the most benefits, including lowering the risk of death from any cause.
Another key is tailoring the therapy to the individual woman. For instance, those who have a history of breast cancer, ovarian cancer, endometrial cancer, blood clots to the legs or lungs, or stroke should probably not take HRT. And those who aren’t especially bothered by symptoms probably don’t need it.
Finally, newer formulations of HRT contain lower doses of hormones, which are believed to render the therapy safer. In addition, such new delivery methods as patches and creams may also avert some of the more concerning side effects like blood clots.
The bottom line is, yes, HRT can be safely used for most women. And your concierge doctors at MD 2.0 have the time to sit down with you and review all the options, the pluses and minuses. So if you’re nearing or in menopause, talk to us. We can help you sort out what’s right for you.