The option of going on hormonal therapy (HT) at the time of menopause continues to be one of the most controversial topics in medicine. Menopause is defined as the lack of menstruation for 12 consecutive months, and usually occurs in North American women around age 51. Once a woman reaches menopause, she is menopausal for the rest of her life. With many women now living well into their 90s, menopause isn’t just a phase—it’s an actual population explosion!
A great deal of information now exists to help the menopausal woman take charge and manage her symptoms, which we know may last for 10 years or longer. As a rule, women with a uterus are generally given estrogen with a progestin for protection against uterine cancer. Many different regimens exist with as many different routes of administration.
Dr. Donna Shoupe, professor of obstetrics and gynecology at the Keck School of Medicine, University of Southern California, recently published an excellent summary of the recent data regarding hormonal therapy. The currently known facts regarding HT, including the risks, are summarized below.
Hormone therapy relieves hot flashes and night sweats, protects against bone loss and osteoporotic fractures, and prevents and treats vaginal dryness. HT can prevent heart attack, decrease overall mortality, lessen menopause-related fat redistribution, protect against menopause-related collagen loss in skin and subsequent wrinkling, lower rates of arthritis, colon cancer, tooth loss, Parkinson’s disease and dementia, improve problems with short-term memory loss and improve cognitive thinking.
The potential risks of HT increase when therapy is started after age 60 and in women who have been menopausal for more than 10 years. These include increased risk of blood clots, stroke, heart disease, abnormal vaginal bleeding and dementia.
The risk of breast cancer actually decreases in women ages 50-59 who take estrogen alone, and slightly increases in these same women taking estrogen plus a progestin, especially after five years.
The current recommendations of the North American Menopausal Society support starting HT around the time of menopause to treat menopausal-related symptoms and prevent osteoporosis in women at high risk for fracture.
The timing of beginning HT is critical in achieving the benefits. Factors that influence the risks of HT include the combined use of estrogen and progestins, the doses used, the route of administration and the duration of use. These considerations must be taken into account, along with a woman’s overall health, family history, lifestyle, menopausal symptoms and treatment goals. Non-hormonal options are also available for many symptoms, and can be used alone or in combination with HT to achieve treatment goals.
Menopause does not have to be miserable. Talk to your health care provider and take charge of your menopause.
Source: Shoup, Donna. Individualizing hormone therapy: Weighing risks and benefits. Contemporary OB/GYN. 2012; August: 16-22.
Dr. Rhonda Robbins is a board-certified obstetrician and gynecologist. She earned her medical degree from Baylor College of Medicine, where she also completed her residency training. She practices at St. Luke’s OB/GYN Clinic in Ketchum, Hailey and Jerome.