Ok, so the title of this post is a little tongue in cheek. Many women are cheering the new research that shows hormone replacement therapy (HRT) used early in menopause is safe and effective. That it helps with our relationship with men, well, that’s a whole other post.
Let’s talk about coping with men: symptoms of menopause affect women differently, but both men and women have shared with me the most significant stressor in their relationships is during menopause. Why? Unfortunately, we do not fully understand the role hormones interact with neurotransmitters (aka, mood) on women during their fertile years, post-partum and through menopause.
Menopause results when ovaries run out of eggs and decrease production of sex hormones: estrogen, progesterone and, testosterone. Symptoms of menopause include: – Pain: arthritic like pain in joints; vaginal pain with or without intercourse – General: fatigue, night sweats, osteoporosis, feeling cold, hot flashes, or sweating – Sleep: early awakening, inability to sleep or not wakening feeling refreshed – Sexual: reduced sex drive or trouble reaching orgasm – Brain: forgetfulness or lack of concentration – Weight: weight gain – Skin: thinning hair or dry skin – Mood: irritability, anxiety, nervousness or depression Also common: shorter or longer periods, breast tenderness, frequent headaches
Women in North America will likely experience natural menopause between ages 40 and 58, although some women experience earlier menopause in their 20’s and 30’s. A study in 2002 changed the lives of menopausal women in America. The Women’s Health Initiative (WHI) hormone therapy trials came to the conclusion that hormone replacement therapy (HRT) was (in summary) dangerous. And many women suffered because of a deeply flawed study.
There were two WHI groups. One took Premarin (Wyeth’s estrogen) and Provera (synthetic progesterone) in a one pill called Prempro. The other group took Premarin alone. The data showed that there was nothing significantly adverse in the estrogen-only group; in fact, there were beneficial benefits to hormone replacement. After 13-years researchers followed up with the groups using HRT and found that the only significant adverse thing was an association between long-term hormone use and breast cancer. Even with that risk, (for women who had never used hormones prior to the study) there was no increase in breast cancer over five years.
Pooled data from new WHI follow-ups, The Kronos Early Estrogen Prevention Study (KEEPS) and Early Versus Late Intervention Trial with Estradiol (ELITE) trials, have revealed a clear bottom line: Wyeth’s synthetic progesterone, Provera (medroxyprogesterone acetate), was “the bad player. Very few doctors use Provera anymore because there are newer and safer alternatives. University of Southern California Atherosclerosis Research Unit chief Howard Hodis stated “The data looked good 13 years ago. The [issue was due to the] way the data was spun.” “But it is reassuring the effects of [hormone replacement therapy] still look so good. HRT as studied by the WHI and observational studies all show that it reduces overall mortality when initiated in young women in close proximity to menopause. In fact, data currently being published show that when women stop HT, death rates increase.”
Several recent well-conducted studies show treating women earlier with HRT has healthy heart benefit, stronger bones, symptom relief and improved well-being. In our clinic women can choose from customized hormone replacement (bio-identical hormones which *may* be covered on an insurance policy) or standard HRT (Vivelle patch, estrace, and progresterone which is covered by most insurance policies). We choose together the option that is easiest for lifestyle and budget. We also discuss how to determine if it’s working and to prevent illnesses, all women prescribed any type of hormone should agree to routine laboratory work, annual well-woman exams and mammography. Hormone replacement is not right for all women, nor is it wrong; it is up to each woman to discuss with her physician to determine the benefits and the risks.