Assisted Loving: Current research on long-term hormone use

By Ginger Manley | Posted: Thursday March 8, 2012

Dear Ginger,

I read your column last month on sex and hormones (Mature Lifestyles, March 2012) and then I saw on Dr. Oz where he had all these experts talking about the same topic. It sounds like there is some new information. What do you think about it?

Marilyn


Dear Marilyn

I am not much of a TV person so I didn’t see the show you mention, but you are right—there is lots of new information, plus new guidelines for hormone use in women. Much of this news was released about the time I submitted last month’s column, so even though I have just covered this topic, I am going to give it another go.

In summary, menopause, the stoppage of all menstrual periods for at least twelve consecutive months, is a normal event in the life of all women, occurring naturally between the ages of about 40 and 55, and sooner for women who have their uterus and or ovaries surgically removed or because of other reasons. When a woman is menopausal she does not make estrogen or progesterone naturally, and many women experience unwanted and unpleasant side effects from not having these hormones.

Effective treatment for bothersome symptoms has involved hormone therapy (HT). HT has commonly included two different options: 1) estrogen plus progestin therapy (EPT) for women who have a uterus and 2) estrogen alone therapy (ET) for women who do not have a uterus.

In 2002, the Women’s Health Initiative (WHI) looked at several facets of a woman’s health and what happened to the women who were receiving one particular kind of HT, the oral form of EPT. Because there were reported to be increased risks of breast cancer, heart disease, stroke, and blood clots with this kind of EPT, many women stopped taking all forms of HT at the time.

More recent review of the data from the WHI has shown that contrary to what seemed to be true a decade ago, it is the type of HT a woman receives (EPT vs ET), how it is taken, and the timing of starting the treatment rather than estrogen itself which is the problem. 

In January of this year, The North American Menopause Society (NAMS), made up of expert clinicians and researchers in women’s health, released a new position statement on hormone therapy, which says “Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms and to prevent osteoporosis in women at high risk for fracture.” To read the entire research article, go tohttp://www.menopause.org/psht12.pdf

On the NAMS website, they have compiled easy to understand guidelines for consumers, which I have copied and pasted into the column.

• HT remains the most effective treatment available for menopausal symptoms, including hot flashes and night sweats that can interrupt sleep and impair quality of life. Many women can take it safely.

• If you have had blood clots, heart disease, stroke, or breast cancer, it may not be in your best interest to take HT. Be sure to discuss your health conditions with your healthcare provider.

• How long you should take HT is different for EPT and ET. For EPT, the time is limited by the increased risk of breast cancer that is seen with more than 3 to 5 years of use. For ET, no sign of an increased risk of breast cancer was seen during an average of 7 years of treatment, a finding that allows more choice in how long you choose to use ET.

• Most healthy women below age 60 will have no increase in the risk of heart disease with HT. The risks of stroke and blood clots in the lungs are increased but, in these younger age groups, the risks are less than 1 in every 1000 women per year taking HT.

• ET delivered through the skin (by patch, cream, gel, or spray) and low‐dose oral estrogen may have lower risks of blood clots and stroke than standard doses of oral estrogen, but all the evidence is not yet available. Research will continue to bring valuable information to help women with their decision about HT.

The NAMS web site is a jewel of helpful information and I hope women and their health care providers will flock to read what is written there. http://www.menopause.org/

While this news may be too late to be of benefit to women who are twenty or thirty years into menopause, this is excellent information for women who are just approaching menopause or who are early into it, like our daughters or granddaughters.

On another front, continuing research is looking at the long-term effects on the brains of women who received estrogen more than twenty years ago and those who didn’t. When all other factors are evened-out, women have about the same risk as men of developing most of the common problems of aging, like heart disease and diabetes, but women have a much greater risk than men of developing dementia. Early studies are showing that the brains of women who have received adequate HT over time are protected much better from dementia than those women who have not received HT.

Stay tuned—I’ll tell you more when I can.

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