Estrogen and Progesterone for Menopause
"If you wait long enough, the pendulum will swing back", is a statement I have made to women patients who had concerns about taking estrogen and progesterone for menopause symptoms. In 2002 the Women's Health Initiative study was all over the news and it implicated hormone replacement therapy (HRT) in causing breast cancer, heart attack, and strokes. No wonder women freaked out, stopped taking hormones and decided to go "Au natural" through the aging process.
A few years later, Oprah started having hot flashes and the subject has been open for more discussion. "Natural" (and unproven) treatments have sprung up and women are more confused than ever about what is safe to deal with hot flashes, sweats, foggy thinking and aching joints that accompany menopause in many women.
The North American Menopause Society (NAMS) has published a formal consensus opinion after extensive review of the current scientific knowledge and health management. They have stated "Recent data support the initiation of menopausal hormone therapy (HT) around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fractures in select postmenopausal women; or both. The benefit-risk ratio for menopausal HT is favorable close to menopause but decreases with aging and with time since menopause, in previously untreated women."
Let me interpret (and add more based on the published document):
- The data shows relieving the symptoms of menopause is worth the small health risk of taking hormones
- For women with osteoporosis, estrogen preserves bone
- The best time to take hormone therapy (HT) is when you are going through menopause and having symptoms. There is less evidence of its benefit in older women who have never taken it previously
- If the problem is mainly vaginal dryness, using topical estrogen is best
- HT is not recommended as the sole treatment of sexual libido decline
- HT doesn't seem to affect weight one way or the other
- Some studies show HT may slow the development of atherosclerotic plaque. The Women's Health Initiative showed women younger than age 70 who started HT had no increased risk of coronary heart disease
- Women with a uterus need to take progesterone along with estrogen, or there is an increased risk of endometrial cancer after 3 years of use
- Women who take estrogen and progesterone have a slight increased risk of breast cancer.
- HT is not a treatment for depression, but it may improve mood in some women
- HT does not prevent aging or dementia
- HT reduced total mortality by 30% when initiated in women younger than age 60
- "Bioidentical" hormones (custom-compounded) have not been tested for effectiveness or safety. There is no scientific basis for using saliva testing to adjust hormone levels.
- Lower doses of hormones are recommended to treat symptoms. Topical progesterone is NOT recommended as it does not protect the uterus.