Menopause and Hormone Replacement

The Women’s Health Initiative Study (WHI) initial results were released about 10 years ago.  These findings caused abrupt cessations of the routine use of hormone replacement therapy (HRT or HT).  The study reported an increase in the risk of breast cancer, heart disease, stroke and blood clots.  Now we know much of this data was not applicable to the general population and the interpretation did not apply to certain age groups or types of HRT.  Continued research has shown the type of hormonal formulations, the route of administration, the timing and duration of use produce different benefits and risks.  The Advisory panel of the North American Menopause Society (NAMS) has new guidelines for clinicians and women to help decide about treatment options.

NAMS has stated the “ absolute risks of Hormone Therapy (HT) in healthy women ages 50-59 are low.  In contrast, long-term HT or HT initiation in older women are associated with greater risks” 

Here are some of their positions.  For additional details, their website is www.menopause.org

  1. For women taking both Estrogen and Progestin for more than three to five years, the risk of breast cancer increases.  For women who have had a hysterectomy and are using Estrogen only for up to 7 years have no apparent increase risk of breast cancer.  (Recent data suggests this maybe up to13 years). 
  2. Progesterone protects against the development of uterine cancer for women taking estrogen.  It is advised that women with a uterus take Estrogen AND Progestin.
  3. Low-dose vaginal Estrogen Therapy is advised when vaginal dryness is the only menopausal symptom.
  4. Hormone therapy does not increase the risk of heart disease in healthy women under the age of 60 and within 10 years of menopause.
  5. Transdermal (skin application) and low-dose oral estrogens have been associated with a low risk of developing a blood clot.

Below, are recommendations by the NAMS panel:

Hot Flashes- Estrogen therapy, with or without progesterone is the most effective treatment for moderate to severe vasomotor symptoms.  “Treatment of moderate to severe vasomotor symptoms remains the primary indication for HT.”

Vaginal Dryness-  “When Estrogen Therapy is considered solely for treatment of vaginal atrophy, local vaginal ET is recommended”

Urinary Tract Health- “Local Estrogen Therapy may benefit some women with overactive bladders.  Systemic HT (taken orally) may worsen or provoke stress incontinence.”

Depression - There is mixed evidence with regards to HT and effects on mood.  HT is not considered and antidepressant and should not be utilized as such.

HRT and the Risk of Breast Cancer:

“Diagnosis of beast cancer increases with EPT use beyond 3-5 years.  A large observational study suggests that EPT with micronized progesterone (Prometrium, for example), carries a low risk of breast cancer with short-term use but an increased risk of breast cancer with all EPT formulations with long-term use”

“EPT as well as Estrogen-only therapy increases breast cell proliferation, breast pain and mammographic density, which may impede the diagnostic interpretation of mammograms, therein delaying the diagnosis of breast cancer”

What about Bio-identical Hormones?

The panel advocates using “well-tested, government approved brand name products” obtained through a prescription.” NAMS provides information on complementary and alternative medicine for women not wanting to take HT.

We recommend that you contact a Gynecologist to help find the treatment best for you when experiencing menopausal symptoms such as irregular and heavy bleeding, enlarging and painful fibroids, hot flashes, night sweats, and vaginal dryness (causing problems with sexual intercourse), and sleep disruption.