YOU CAN CONSIDER HORMONE THERAPY AGAIN!
ByThe North American Menopause Society, NAMS, has recently released a new position paper on the use of hormone therapy during and following menopause. An analysis of several studies and data has shown that hormone therapy is not as dangerous or onerous as believed 10 years ago after the initial release of the Women’s Health Initiate study results.
The Women’s Health Initiative was designed to determine if HRT was cardioprotective; as well as to help determine if HRT caused an increase in breast cancer. This study was stopped prematurely due to an increase in cardiovascular events including stroke, heart attack and blood clots. Hormone therapy was quickly blamed for this increase in cardiovascular events, and consequently usage has plummeted.
You may be asking what is new about all this information?
Researchers have been continuing to analyze the data from this study, and have come to some conclusions which have helped guide NAM’s new position paper. This is what they have determined:
- Most cardiac events occurred in women over 60 who were placed on hormone therapy 10 or more years after menopause.
- Women who underwent hysterectomy and were placed on estrogen without progesterone had a lower rate of breast cancer, therefore taking estrogen for up to 7-8 yrs was not associated with increase risk of breast cancer.
- However, HRT started at time of menopause was associated with slightly higher risk of breast cancer than when started a few years post menopause.
- Women on estrogen therapy (ET) and estrogen/progesterone therapy(EPT) had lower rate of cardiovascular events when HRT was started at time of menopause, as opposed to several years post menopause.
- The types of estrogen and types of progesterone may influence risk of breast cancer and cardiac events.
What does this mean for you?
The recommendations suggest that you can expect the have your hormone therapy customized to your particular medical situation, including consideration for your risk for breast disease and heart disease.
For those of you who have had a hysterectomy, you could reasonably take your estrogen therapy for up to 7 years without significantly increasing your risk of breast cancer.
For those of you who still have a uterus, you would want to limit your use of HT for 3-5 years. After this, your risk of breast cancer increases.
The type of progesterone therapy may affect the risk of cardiovascular events. A natural progesterone, such as Prometrium, may have significantly less risk than synthetic progesterone, for both cardiovascular events and possibly breast cancer.
The route of delivery of estrogen may lessen the risk of HT. Topical estrogen, or estrogen patches may have less risk of thrombotic events; than oral estrogen.
Estrogen is the most effective therapy for vulva and vaginal atrophy, with topical vaginal cream, ring and suppositories being superior to oral estrogen.
Compounded Bio-identical hormones should only be used if an allergy to a component of federally approved estrogen or progestin hormone therapy exists. These compounded hormones have not been tested and may contain levels of hormones or ingredients that are harmful. For this reason, safety cannot be established as clinical trials proving safety have not been performed.
Hormone therapy can be very helpful when you are first experiencing menopausal symptoms. Now, with this statement paper, there is more guidance on safety of HRT use. Compounded Bio-identical Hormones are very popular, but their safety has not been establishes in the types of studies that this position paper discusses. There are many safe options for women that include patches, creams as well as pills; and this allows flexibility in dosing. This is is a form of customization.
This is information that you can use when you see your medical provider. Write in and share your own experience with HRT and whether or not it has helped, and even which preparation you used (your information is anonymous to our readers). It is through sharing information that we can enlighten one another about menopause and strategies to ease the common problems.
Dear Anne,
I just turned 60 a few weeks ago and have been diagnosed with osteoporosis along with my menopause symptoms. I lost my good medical insurance about 2 years ago, so I have a county doctor who has taken me off of my estroidal meds because she says I am at a risk for stroke and heart attack. She has prescribed Fosamax for my osteoporosis. I am terrified from reading the findings of what the side effects are for this drug, so I have chosen NOT to take it and to find some alternative for the problem. I had a partial hysterectomy in 1991 and my tubes and ovaries were removed Jan. 25, 2010 so I have ZERO hormones which leave me very fatigued along with hot flashes all day long. I feel like I have lost so much of my health in the past 2 years and I just would like to feel some energy back, get a little sleep, stop the hot flashes, night sweats and get some guidance on what an alternative would be for my osteoporosis instead of taking Fosamax. I deeply appreciate any help or advice for these issues. Thank you and God Bless You for creating this blog!!!
Dear Kathi,
I can appreciate the discomfort and bewilderment you might be feeling!
While I cannot be your medical provider, I do have some thoughts on what you might talk to your provider about.
Your osteoporosis will require you take adequate calcium, vitamin D, as well as regular weight bearing exercise. This will help you to build new bonel
If you osteoporosis is severe enough, I suggest you talk with your provider about the risks of Fosamax. It may be worth taking
for 2 years to help boost bone density while you work on supplements and exercise.
Exercise will also help your sleep and possibly hot flashes. There are a few medications that can be used for hot flashes and sleep
that are not hormones, and you can talk to your medical provider about this also. These would include some antidepressants used at lower doses. Many
herbs such as black cohosh and soy can be helpful to lessen hot flashes. A diet low in sugar, alcohol, nicotine(none); and avoidance of spicy foods and hot foods can help to lessen hot flashes. Adding in the cruciferous vegetables also helps lessen hot flashes.
The risk of heart disease does go up as we age, and depending on your family history, continued use of estrogen may be placing you at risk.
Estrogen if often the most effective treatment for all of your issues, but lifestyle and diet are very powerful tools you can also use.
It is important to talk to your provider about different options for treatments for all these aspects of menopause,
Good luck and let me know what works for you!
Anne