Hormonal therapy can be used for menopause and long-term health

In recent Dr. Monica Christmas's clinic, she has seen two types of menopause patients. She said she was suffering from symptoms related to this at first. Life phaseHowever, I have heard that hormone therapy also has related health risks, so I am also wary of hormone therapy.

The second type of patient is almost the opposite. She may not have any symptoms at all, but she still wants hormones.

“We seem to like these extremes,” said Dr. Christmas, director of the University of Chicago's Menopause Programs Programs and Women's Integrated Health Center.

Prescription data reflects persistent anxiety about health risks: in research Released in Septemberresearchers found that in 2020, only 5% of women in menopause use the hormone, even though around 80% of women experience symptoms.

Conversely, the number has increased over the past few years Social Media Influencer And celebrities like Oprah Winfrey were loudly supporters of hormone therapy and presented it as a “magic elixir,” Dr. Christmas said.

“Now there's this message that every woman in menopause should get hormone therapy,” she said. However, women need to be more clear about what hormone therapy can and cannot be done. “We have to find a way back to the ”

What is menopause hormone therapy?

Menopause hormone therapy (MHT) supplies some of the estrogen and progesterone lost during menopause. The Food and Drug Administration has approved dozens of treatments It has been shown to ease A set of narrow symptoms including vasomotor symptoms such as multiple flashes and night sweats. Urogenital syndromerefers to painful sex, vaginal dryness, and urinary tract infections. Hormonal therapy can also be used to prevent it Postmenopausal bone loss.

There are two broad categories of hormone therapy. In systemic form, hormones can affect the whole body and are localized to be applied to the vagina. Systemic treatments include either estrogen alone or a combination of estrogen and progestogen (a synthetic version of progesterone), and are offered in the form of a pill, patch, gel, cream, spray, or vaginal ring. They can tackle hot flashes and night sweats and prevent osteoporosis.

Systemic estrogens themselves can lead to thickening of the uterine lining, which increases the risk of endometrial cancer, said Dr. Stephanie Faubion, director of the Mayo Clinic Women's Health Center and medical director of the Menopause Society. Women who have removed the uterus can safely use only estrogen, while other women need to take some form of progestogen to counter its effects.

Local treatments applied to the vagina are low-dose estrogens and are primarily intended to deal with symptoms Dry vaginal And the pain of sex.

MHT is not approved to treat numerous other menopause symptoms, including depression, anxiety, frozen shoulder, weight gain, and hair loss, says Makeba Williams, Ph.D., an obstetrician and gynecology professor at Washington University School of Medicine in St. Louis. However, the Menopause Society, which sets treatment guidelines, noted in its annual position statement that some patients starting hormone therapy also show minor improvements in some of these symptoms.

Previous versions of FDA-approved hormone therapy, which are still available today, contain what is called conjugated estrogens derived from the urine of pregnant horses, but products that are more commonly prescribed today (also approved by the FDA) contain what is called biological estrogens derived from plant sources. According to Dr. Faubion, there is no quality study comparing head-to-head had between conjugated hormones and biologically identical hormones, so there is no detailed understanding of how risks and benefits differ.

For who is it?

According to the Menopause Society, hormone therapy provides more effective relief, reducing the risk of women suffering from vasomotor symptoms or urogenital syndrome; Less than 10 years or less than 10 years Compared to those who started it later in their lives, from their last days.

Hormonal therapy is not recommended as it can worsen these conditions in women with a history of stroke, heart attack, blood clots, liver disease, vaginal bleeding of unknown cause, or estrogen-sensitive cancers such as the breast or uterus.

What do we know now about the risks and benefits of hormone therapy?

In 2002, the Landmark Women's Health Initiative Study, a long-term and only long-term randomized trial, stopped early in 2002 as researchers found that treatment increased the risk of breast cancer and cardiovascular events. This study has produced widespread panic that led to women abandon their treatment.

However, since then, researchers have reanalysed the data, and follow-up studies have found a more nuanced picture: the dose, delivery method, and the age at which treatment was started all make a big difference in risk, Dr. Makeba said. And often, the advantages include an Improve quality of life – It can outweigh the risk, she added.

Among symptomatic women under the age of 60, the reanalyzed WHI data showed that of the 10,000 women using hormone therapy (particularly conjugated estrogen and progestogen tablets), there were five cases of breast cancer, rather than breast cancer-related deaths, and five additional cases of coronary heart disease and stroke.

Hormonal therapy, meanwhile, significantly reduced the risk of fractures, all-cause mortality and diabetes. Research has found that hormone therapy is consistently reduced in women taking estrogen alone breast cancer and Cardiovascular Risk – That's right It's not fully understood yet.

Untreated menopause symptoms are long-term linked Chronic health In later life, Neurodegenerative diseasesit is still unclear whether the symptoms cause poor health or if they are markers of another underlying problem.

Menopause Society For women who have started hormone therapy after the age of 60, risk Increased breast cancer and cardiovascular events.

“If you read the labeling on the package, you'll say, 'This might give you breast cancer, this might cause a heart attack.' But “We must continue to educate us on real risks, benefits, and what hormone therapy is and is not appropriate.”