Hormone therapy at the time of menopause and beyond is one of the most controversial subjects in Gynecology. Historically, the replacement of Estrogen and Progesterone was felt to have nothing but benefits. Increased bone health, reduction in hot flashes, and relief from atrophy of the genital tissues are all known benefits. It was once thought that Hormone Therapy (HT) improved heart health since women develop heart disease in general later than men. Lower risk of heart disease has not been proven, and it may increase the risk of certain cardiovascular conditions. There also appears to be a slight increase in the risk of some types of breast cancer in long-term users of HT. So, why would we use HT knowing the risks? In short, it is because menopause can be miserable for some women!
Menopause occurs on average around age 50 and is defined as no periods for at least a year. The transition leading up to menopause and afterward can be a time of great distress for many women. Hot flashes are often more than just a nuisance, and at night, when they manifest as night sweats, they can be very disruptive to sleep. Mood changes are common, and there can be gradual atrophy of genital tissues leading to dryness, irritation, painful intercourse, and urinary problems.
Many women have mild menopausal symptoms and don’t require HT. However, for the women who suffer from more severe symptoms, it can be a lifesaver to use Estrogen, usually along with Progesterone, to alleviate many of these symptoms. Essentially, one must weigh the risks that are small but real against the quality of life issues. Sleep disruption, in particular, can lead to poorer health and quality of life. Low doses of HT can diminish Hot Flashes and night sweats, decreasing distress and improving sleep quality. Oral pills, topical gels, sprays, and patches are all effective. Vaginal estrogen creams can improve symptoms of genital atrophy in women for whom hot flashes are not a problem.
There are pros and cons to HT, and some women should avoid it altogether if they have specific medical issues. For those who do need HT, we usually try for the lowest dose and consider discontinuation after a time. Whether or not to use HT is a joint decision between you and your doctor. Fear of hormones should not deter women from using HT when appropriate. After all, your body was making these same hormones for 40 years before menopause!
David Laraway, MD
Canyon View Women’s Care