A New Perspective on Hormone Therapy

By: Red Hot Mamas

Published: March 14, 2012

For many years preliminary research showed that hormone therapy could lower the risk of heart disease in women and it’s use was the standard treatment for the prevention of heart disease, hot flashes, night sweats, vaginal dryness and other menopause symptoms. The Women’s Health Initiative (WHI), a large randomized clinical trial included studying postmenopausal women using hormone therapy. Women with a uterus were given estrogen plus progestin (E+P) to protect the endometrium (lining of the womb) and women without a uterus were given estrogen (E) alone. The average age of initiating hormone therapy in the study was age 63 years. These were older women who had more absolute risks for chronic diseases.

The E+P trial was stopped three years early because overall there were more risks than benefits and the estrogen alone trial was stopped one year early due to risk of stroke but there was more balance of benefits and risks. Findings in these older women were used to make decisions about the use of hormone therapy (HT) in women in general and as a result many women stopped taking their hormones because of fear of getting breast cancer, heart attacks and strokes and many health providers discontinued prescribing these medications to women.

In practicing evidenced-based medicine, the information from the entire body of available medical research is interpreted and used to provide guidelines for healthcare practitioners to manage medical conditions. Latest research findings show that hormone therapy has a different effect in younger women with healthy blood vessels compared to older women with atherosclerosis. Age, age at menopause, cause of menopause, time since menopause and a woman’s risk of having or developing a disease at menopause and beyond are important considerations before electing to start hormone therapy use because these baseline risks my attribute to their developing an adverse event. The North American Menopause Society’s current guidelines state that hormone therapy should not be used for disease prevention and current evidence supports the initiation of hormone therapy around the time of menopause to treat menopause-related symptoms. Treatment should be consistent with goals to be achieved and it is important to balance the benefits and risks of treatment for each individual woman. Most women who take hormone therapy for symptom relief usually start around the time of menopause and not in their later years.

Moderate to severe vasomotor symptoms (hot flashes and night sweats) are still the primary indication for hormone therapy and HT is still the most effective treatment option for relief of symptoms. Women are able to sleep better and they experience a better quality of life. E+P can be used for up to five years and estrogen alone can be used for up to seven years before breast cancer is an issue. Local estrogen therapy is effective in treating moderate to severe vaginal atrophy and painful intercourse can be relieved. Improvement in sexual satisfaction and restoration of the acidic vaginal environment with predominantly lactobacillus flora can control the growth of bacteria that may cause urinary tract infection.

Women who start hormone therapy more than 10 years post menopause are at a greater risk of developing CHD and stroke than those who start less than 10 years post menopause. HT should not be used in asymptomatic women for primary prevention of heart disease and women who had venous thromboembolism (VTE) are at a greater risk of VTE with HT use. Safety in using HT can be optimized by selecting non oral routes of administration (patches, creams, gels, sprays, rings). Bioidentical hormone medications that are custom-compounded recipes prepared by pharmacists do not have FDA approval because preparation methods vary from one pharmacist to another and patients may not receive consistent amount of medication. Reliable sterility and freedom from undesirable contaminants are also concerns.

Hormone therapy has been shown to reduce new onset of type 2 diabetes, improve insulin resistance in postmenopausal women and reduces postmenopausal osteoporotic fractures including hip fractures even in women without osteoporosis. Hormone therapy is approved for the prevention of postmenopausal osteoporosis and its use can be continued long-term. It is important to review changes in risks and benefits annually because these can change over time.