Hello and welcome to part 3 of my Menopause Series! Over the past few weeks my goal has been to provide you with helpful information allowing you to take control of the changes that occur during menopause. I have found often times women are overwhelmed because they don’t understand where to get the facts they need. Today I want to share insightful information about Hormones, the good, the bad and the ugly.
I don’t know about you, but lately I have started to dread mid-afternoon. That seems to be when my daily meeting with peri-menopause occurs, if that is her name. I’m a 40-something well-trained medical professional and even I am uncertain about my symptoms. Interestingly, she only comes to visit at work or when I am stressed, usually during the mid-afternoon slump. Without invitation, she consistently brings along her partners, an unfriendly flush, a slight sweat and a foggy brain all unwelcome visitors to my office. I, too, must consider whether and when to start hormone replacement therapy (HRT).
Many women do not need medications of ANY kind to gracefully manage their menopause. There is no clear evidence that hormones will improve quality of life for women who are NOT adversely affected by menopausal symptoms. Thankfully, for women who have symptoms related to a lack of estrogen (such as hot flashes, night sweats and vaginal dryness), there is relief with estrogen replacement. Recall that estrogen MUST be accompanied by progesterone for all women who have not had a hysterectomy and still have a uterus.
Currently, the pendulum has swung back from the fear elicited by the 2002 publication of the Women’s Health Initiative (WHI) that found higher rates of coronary heart disease, stroke, blood clot formation and breast cancer in women taking combination estrogen and progesterone in a pill form. These risks are still the ones that ALL women taking ANY type of hormones need to be aware of. Even hormones outside conventional HRT such as custom-compounded or unapproved bio-identical versions all function in, basically, the same way on hormone sensitive tissues within the body. Despite the fear and terror struck by the WHI in patients and physicians alike, more recent information and re-analysis of the WHI data has revealed that HRT may be safer than once thought. Estrogen alone may, actually, reduce heart disease when it is initiated in women soon after menopause strikes. Younger women taking hormones have no increased risk of stroke if they start their therapy within 10 years of menopause and estrogen applied through the skin (eg. Patch or gel) does NOT increase blood clot formation or stroke risk. Although rare, the risk of blood clots is a real and persistent finding for women on oral hormones and is higher in obese women. With respect to breast cancer, rates are higher for women taking their hormones for more than 3-5 years, however, estrogen without progesterone seems to be consistently less risky for those who have had a hysterectomy.
In general, women who start their hormones soon after menopause or in the peri-menopause, can do so very safely. Individual counseling by an educated healthcare provider will help you understand your personal risk profile.
Recent evidence confirms that estrogen and, less so, progesterone relieve vasomotor symptoms causing hot flashes and night sweats. It is no big leap to deduce that relief of these symptoms improves quality of life for women whose daily activities are affected by such symptoms. The big consideration is whether the benefits are worth the risks, however small. Let’s consider some additional benefits of hormones.
Many estrogen and progesterone products prevent post-menopausal bone thinning, however, they are not used for treatment once the bones have already become thinned as with osteoporosis. Often menopausal memory decline becomes the punch-line for jokes, but it is truly not a laughable matter. We know that cognitive performance falls off with age and many studies have sought to determine if this deterioration can be reduced with hormone replacement. The answers are not clear, however, some postulate that hormones need to be taken very close to the onset of menopause to be effective in this regard. On a positive note, studies seem to suggest that the peri-menopausal diminution in memory and learning actually improves as the transition to menopause progresses. As our brains bathe in their “new” hormone pool, we can think-straight again! There is light at the end of the peri-menopause tunnel. If you feel depressed, you should seek medical attention but hormones are also known to alleviate mildly low mood or stabilize menopausal mood swings. You don’t have to hate everyone while you go through the change. If your “prune-like” vagina is your biggest issue, many types of hormones can be used to treat vaginal dryness, sexual pain due to vaginal dryness, overactive bladder and recurrent urinary tract infections. It is a sad reality that many women grit their teeth through painful sex or remain hushed about bladder dysfunction and end up with worsening pelvic floor problems. Be sure to seek help if sex is not comfortable or you are awake peeing all night long! By taking time to talk to
Please be sure to be informed, speak up and ask questions! There is an entire community of women here to provide support and guidance for you. Next week please come back where we talk about a very important topic Menopause Series: Part 4 Why trust your Doctor? We all must be intentional to build trust between patients and doctors through open communication and continued learning about your health and wellness!
Be good to yourself this week!