Helping Women Navigate the Hormone Replacement Therapy Debate

By Sondra Forsyth

The end of the “hormone therapy era” appears to have been greatly exaggerated. More than a decade ago the Women’s Health Initiative published in an article in the Journal of the American Medical Association advised menopausal women to stop their hormone replacement therapy due to a reported increase in breast cancer, strokes, and heart attacks.

In the years since then, however, potential flaws and limitations with that study have come to light, and the pendulum may have swung back the other way.

The North American Menopause Society, the American Menopause Society, and the International Menopause Society all now say the risk-benefit ratio favors hormone therapy when it is initiated near the time that menopause begins.

All that back and forth may have left some women puzzled and frustrated, and October, which is World Menopause Month, is the right time to increase their awareness of the latest views on the subject.

“Trying to wade through all the studies and opinions over the years can definitely get confusing for patients,” says Dr. Diana Hoppe, an obstetrician/gynecologist and founder of Amazing Over 40 Inc. (www.amazingover40.com), a health coaching certification program for women.

“But I think more and more we are seeing that while, yes, there are risks, there are also benefits and each individual situation is going to vary. That’s why an in-depth talk with your doctor is important.”

Women who have gone through menopause are familiar with the symptoms brought on by their lower hormone levels: hot flashes, night sweats, mood swings, irritability, decreased concentration and focus, decreased sex drive, and vaginal dryness.

Doctors sometimes try to help them combat those symptoms by giving them estrogen or progesterone.

Hoppe says there are strategies that women and their physicians can use to increase the benefits of hormone therapy and decrease its risks. Here are three examples:

• Start early because timing is critical. Women should begin the therapy within the first 10 years of the onset of menopause, and they should be younger than 60 when they start. Just recently, a Swedish study suggested that the impact of hormone therapy on heart disease depends on how quickly women start the therapy, according to the North American Menopause Society. The study, which was presented September 30th 2015 at the society’s annual meeting, showed that women who start taking hormones shortly after the onset of menopause remain free of coronary heart disease for longer periods of time.

• Use the lowest effective dose that works. The lower the dose to treat symptoms, the better because that in turn lowers the risk of side effects.

• Be truthful about risk factors. The more your physician knows about your health-related habits and background, the better, Hoppe says. Risk factors for hormone therapy can include smoking, family history of heart disease, high cholesterol profile, history of clotting disorder, and liver disease.
Ultimately, it’s important for women to engage in a discussion with their physician about what they are going through, Hoppe says.

She says that discussion should include the specific symptoms a woman is  experiencing; what bothers her most about those symptoms; her goals for doing something about the symptoms; the lifestyle changes or herbal remedies she has already tried; her feelings about taking estrogen; and any concerns she may have about hormone therapy.

“One more thing to remember is that while millions of women are going through the same thing as you, you also are unique,” Hoppe says. “There is no one-size-fits-all approach for menopausal management. You and your doctor should work together to figure out what is best for you because you want to make this phase of life the fullest it can be.”

Dr. Diana Hoppe, an obstetrician and gynecologist, is the founder of Amazing Over 40 Inc. (www.amazingover40.com), a health coaching certification program for women. She also is an author and speaker who has been featured on a number of TV shows, including “Dr. Oz.“