Hormone replacement therapy — not so scary after all

Drs. Tristi Muir and Catherine Hansen

Drs. Tristi Muir and Catherine Hansen

For menopausal women who have symptoms related to a lack of estrogen such as hot flashes, night sweats and vaginal dryness, hormone replacement therapy can offer great relief.

A decade ago when the Women’s Health Initiative famously announced that menopausal women who took hormones had higher rates of coronary heart disease, stroke, blood clot formation and breast cancer, women abandoned their hormones in droves. But now, newer research has shown that wholesale elimination of hormone therapy for all menopausal women may not make sense.

All women taking any type of hormone need to be aware there can be risks. Even custom-compounded or bio-identical hormones function in basically the same way that traditional hormones do on hormone-sensitive tissues within the body.

Despite the fear and terror experienced by patients and physicians alike after the WHI announcement about the dangers of traditional hormone replacement therapy, more recent information and re-analysis of the data has revealed that it is not really so dangerous after all — at least for some women.

Estrogen alone may actually reduce heart disease when it is initiated in women soon after menopause strikes. Younger menopausal women taking hormones have no increased risk of stroke if they start their therapy within 10 years of menopause.

Although rare, the risk of blood clots is a real and persistent finding for women on hormones and is higher in obese women. Obesity, by itself, is also a health risk. With respect to breast cancer, rates are higher for women taking their hormones for more than three to five years. Estrogen without progesterone is less risky, but only women who have had a hysterectomy can safely take estrogen alone.

In general, women who start their hormones soon after menopause or in the peri-menopause period can do so very safely. Individual counseling by an educated health care provider will help you understand your personal risk profile.

Let’s consider some additional benefits of hormones.

Many estrogen and progesterone products prevent post-menopausal bone thinning. They cannot, however, be successfully used for treatment once the bones have already thinned as in osteoporosis.

If the vagina is your main menopausal issue, many types of hormones can be used to treat vaginal dryness, sexual pain due to vaginal dryness, overactive bladder and recurrent urinary tract infections. It is all too common for women to grit their teeth through painful sex or remain hushed about bladder dysfunction and end up with worsening pelvic floor problems. Be sure to seek help if sex is not comfortable or you are awake peeing all night long.

Menopausal memory decline is a punch-line for jokes, but it is no laughing matter for those women who experience it.

Some experts say that hormones taken very close to the onset of menopause can reduce the deterioration in memory and cognitive performance associated with age. Other studies suggest that the peri-menopausal diminution in memory and learning actually improves as the transition into menopause progresses.

As our brains bathe in their new hormone pool, we can think straight again. There is a light at the end of the peri-menopause tunnel.

Drs. Tristi Muir and Catherine Hansen are gynecologists at the University of Texas Medical Branch at Galveston. For more information, go to www.utmbhealth.com/pelvichealth.

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