Hormone Therapy: Good or Bad?

Before 2002, most women used hormone therapy to treat menopausal symptoms, improve quality of life and long term health. Then in 2002 a large clinical trial showed health risks. Fear and confusion ensued. But now there’s good news…10 years of research later, what do we know and what does this mean to you?

Prior to 2002, 30 million women in the USA were taking hormone medication and Premarin and Provera were the one of most prescribed drugs in the USA.  It was felt that hormone therapy reduced cardiovascular disease and provided significant quality of life benefits. In 2002 a major research study, the WHI, was conducted that threw a bombshell on the treatment of menopause – the study showed an increase risk of heart attacks, stroke and breast cancer. As a result millions of women went off of hormone therapy, but  the use of antidepressants increased by 50%, use of tranquilizers doubled, the number of fractures seen in women increased and women suffered as symptoms were left unanswered. Women were told that it’s a part of life so we need to deal with it.

But women demanded answers. After more than 10 years of further research, review of clinical trials and new evidence show that hormone therapy may be very beneficial for some women, depending on their risk factors.

Here are some of the new findings:

  • The optimal timing to start hormone therapy is within 10 years of menopause.
  • Women between 50-59 showed no increased risk of breast cancer, no increased risk of heart disease and stroke
  • The type of hormones are important: transdermal estrogen and micronized progesterone appearing to be the safest and most beneficial.
  • Estrogen appears to help prevent insulin resistance and diabetes, has a favourable effect on cardiovascular biomarkers and blood pressure, and when started early in menopause appears to help prevent the progression of atherosclerosis (cholesterol plaque)
  • Hormone therapy is still the most effective treatment for menopausal symptoms such as hot flashes and insomnia. It can also help with mood, verbal learning and sexual function. Hormone therapy significantly improves quality of life for many women
  • HT is associated with a decrease risk of osteoporosis and fracture, and bowel cancer

How do you decide if Hormone Therapy is right for you?

Talk to your doctor – you need a professional that understands your medical history, personal benefits and risks. A doctor who is open and aware of the current research will be able give you the best advice.

  • If you have Premature menopause (<age 40) – see your doctor. Women who have premature menopause and are not on hormones are at an increase risk of cardiovascular disease, osteoporosis, earlier death, dementia, anxiety/depression and sexual dysfunction

Get Educated –Hot flashes are not the only symptoms of menopause  – Quality of life can be significantly affected as many women experience fatigue, insomnia, mood alterations, vaginal dryness, and palpitations that are often related to hormonal changes.

If you are taking Hormones, how do you optimize your treatment?

Find the right type for you:  Your doctor can help decide what type and dose of hormones are best given your needs and medical history.  We now have many more choices in tailoring therapy.

Have regular follow up care: See your health care provider regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for screenings such as mammograms and pelvic exams.

Adopt a Healthy Lifestyle: Effective stress management, regular exercise, healthy body weight, minimizing alcohol, not smoking, and eating a healthy diet all contribute to optimizing hormones effects in the body and minimizing risk. Women who have healthier lifestyles have healthier outcomes with hormones.

Remember the other hormones: Estrogen and Progesterone do not function alone in the body. Thyroid, cortisol, testosterone, insulin, are all other key players in the symphony of hormones and play a critical role in maintain optimal function.

Be informed and Take Charge: Reading current information and understanding the ongoing research allows you to play an active role in the best decisions for your health.

So where do we stand?

When hormone therapy is started near menopause, the research supports benefit over risks with a trend toward disease prevention and healthier long-term outcomes. The North American Menopause society, The International Menopause Society and the Endocrine Society advocate the consideration of use of hormone therapy as part of an overall strategy for maintaining the health of post-menopausal women, while improving quality of life. Individual risk assessment, personalized treatment and lifestyle modification is key in obtaining the most optimal outcomes.

For more information and educational seminars on hormone health, please visit www.westcoastwomensclinic.com

By: Dr. Bal Pawa, B Pharm, MD
and Dr. Nishi Dhawan, MD
Westcoast Womens Clinic

1. WHI sub study ages 50-59,  Nurses Health Study, E3N study, ESTHER trial, WISE study, Danish study, KEEPS trial