Understanding Menopause and Hormonal Therapy

Menopause can trigger a variety of challenging symptoms—think hot flashes, night sweats, and trouble sleeping. Hormonal therapy might offer some much-needed relief.

But many women are hesitant about starting it. The topic has been fraught with uncertainty, especially after a recent expert panel meeting organized by the Food and Drug Administration.

While hormonal therapy was commonly prescribed in the past, things took a turn in 2002 when a study was halted over worries about an increased risk of breast cancer and blood clots. Although subsequent research indicated that for many women, the benefits of modern hormone therapy outweigh these risks, doubts linger.

“There’s still a lot of confusion and a lot of fear,” said Grayson Rebellenz, 50, from Durham, North Carolina.

Despite the hesitations, more people are beginning to reconsider hormonal therapy. Yet, experts seem to have differing views on how to communicate its pros and cons. The FDA panel highlighted various benefits and even suggested that some health warnings should be reconsidered.

Doctors are generally optimistic about hormone therapy as a viable option for many women during menopause. However, it’s crucial to grasp the nuances of these treatments before making any decisions.

How Hormone Therapy Works

This treatment aims to alleviate symptoms that arise after menstruation ceases, which can lead to notably low estrogen and progesterone levels.

One method is low-dose vaginal estrogen therapy. Since it’s applied vaginally, it doesn’t circulate widely in the bloodstream, thus lowering potential risks. This is often a good choice for women struggling primarily with vaginal dryness.

On the other hand, systemic therapy involves medications like pills, patches, sprays, gels, or vaginal rings that release higher levels of hormones into the bloodstream, effectively targeting symptoms like hot flashes. This includes both estrogens and progestogens.

Take Jennifer Zwink, a nurse in Castle Rock, Colorado. She started using estrogen patches over a year ago, along with an IUD for progesterone. The combination has greatly reduced her hot flashes and improved her sleep, easing joint pain and bloating. “It’s not like a 100% magic wand,” she noted, “but it definitely made a huge difference.”

The Menopause Society suggests that hormone therapy can reduce the risk of heart disease if initiated within ten years of menopause. It may also lower the risk of type 2 diabetes and help maintain bone density for longer.

As Dr. Margeva Morris Cole from Duke University puts it, “They may have lower bone density at age 60 rather than 50.”

Risks of Hormonal Therapy

When Leberentz first considered hormone therapy last year, she grappled with the potential risks she had heard about. Eventually, she decided that living in discomfort was no longer an option.

The combination therapy transformed her experience—boosting her mood, improving her sleep, and eliminating joint pain and hot flashes. “I feel like I am again,” she shared.

Doctors often try to reassure patients, but many remain cautious. The Menopause Society indicates that women can use estrogen therapy for up to seven years, and estrogen-progestogen therapy for three to five years before seeing a significant increase in breast cancer risk.

While both therapies can elevate stroke risk, this disappears shortly after discontinuing the hormones. Oral hormone intake raises the risk of blood clots, while alternatives like patches or gels may reduce it.

“Many of these risks are small,” said Dr. Nanette Santoro from the University of Colorado. “And they must be weighed against the benefits of symptom relief.”

Factors like age, medical history, and the duration of hormone use are important considerations. It’s not uncommon for women to be on hormonal therapy for roughly five years, although those with specific conditions may receive different recommendations.

Discussions About Hormonal Drug Warnings

There’s a divide among doctors regarding potential changes to the “black box” warnings that accompany certain hormonal treatments. All estrogen medications still carry warnings about stroke risk, blood clots, and cognitive issues.

The recent FDA panel consisted of experts who have had ties to pharmaceutical campaigns advocating for hormones, or opposing warning labels. A letter signed by 76 doctors and researchers cautioned that removing these warnings without scientific review could endanger patients, advocating for further discussions before any decisions are made.

In the meantime, clinicians encourage people to be cautious about misinformation, particularly misleading social media claims suggesting that hormones prevent dementia or guarantee healthy aging.

“I can’t promise that taking hormones will lead to a longer, healthier life,” remarked Duke’s Cole. “I don’t want people to think it’s a guarantee for the next 30 or 40 years.”

Alternatives to Hormonal Therapy for Menopause

Santoro mentioned a new non-hormonal medication called fezoline, sold as Veza, which targets hot flashes and night sweats. Gabapentin, a low-dose antiepileptic drug, can also help with hot flashes, and various moisturizers can assist with vaginal dryness.

Experts advocate for regular exercise and a nutritious diet as effective methods for managing menopause symptoms.

Santoro also called attention to the surge of supplements marketed as menopause remedies. “Everyone is getting in on the menopause gold rush,” she noted. “If it seems too good to be true, it probably is.”