More and more women are suffering from menopause

more women worried Hormone therapy options should be presented for ‘debilitating’ symptoms of menopauseAccording to a paper published Monday in the Canadian Medical Association Journal (CMAJ).

“There are many different symptoms of menopause and peri-menopause, some of which can be extremely debilitating, especially for today’s younger women,” says endocrinologist Dr. Ileana Rega of Women’s College Hospital in Toronto. Stated. Lead author of the paper.

“Every day I see how few women are being asked about menopause and being told how to treat it. I see a continuing need to improve education on this subject,” she said.

Women in their 40s and 50s may be raising children and peaking in their careers while battling distressing symptoms, she said.

“Sleep disturbances, frequent hot flashes, irritability and mood problems can have a significant impact on daily life,” Rega said.

Menopausal hormone therapy, also known as hormone replacement therapy, has been controversial since the 1990s when major studies linked it to increased rates of breast cancer and stroke.

However, many experts now argue that the study overestimates the risks associated primarily with women over the age of 60—because aging increases the risk of these conditions anyway. To.

Lega and co-authors reviewed more recent studies and found that women in their 40s and 50s had a much lower risk, especially if they had used hormone therapy for 5 years or less.

For women between the ages of 50 and 59, or those who started hormone therapy within 10 years of their last menstrual period, “estimated 3 additional breast cancer risks for every 1,000 women who used postmenopausal hormone therapy for 5 years. It is done.” Their review read:

“Combined” menopausal hormone therapy combines estrogen and progestin.

The review also found a very low risk of stroke in people under the age of 60 who use hormone therapy.

“Certainly for women over 60, the argument is very different,” Rega said. “Normally, initiation of hormone therapy is not recommended in that age group.”

This review article is not intended to suggest that all women should receive menopausal hormone therapy, but rather to help providers discuss options with their patients and weigh the risks and benefits on an individual basis. The aim is to provide the necessary information to the public, he said.

Dr. Iris Golfinkel, a family physician in Toronto who was not involved in the paper, agreed.

“You have to put current suffering on one side of the scale and consider potential harm on the other side of the scale,” she said.

To assess potential harm, Dr. Golfinkel talks to patients about the possible presence of BRCA gene mutations that are associated with an increased risk of breast cancer, along with their family history.

She does the same to assess risk for heart disease and stroke, and discusses family history and other factors such as smoking, diabetes, and high blood pressure.

On the other hand, it’s important not to underestimate the amount of suffering patients are experiencing with menopausal symptoms, says Golfinkel.

“Patients may recognize that this can be a ‘life change,’ but many do not realize that perimenopause can last as long as 10 years.” she says

“I think for a long time medical science has told women to shut up and put up with it,” said Golfinkel. “It’s getting worse and worse, and many women keep telling themselves, ‘You should get used to it, you’ll be fine.'”

Menopausal hormone therapy is up to 90 percent effective in treating hot flashes and improves sleep quality and mood disturbances, says the review paper.

It also helps prevent loss of bone density.

“This is a huge advantage because when a woman or man falls and breaks a hip, it can change their lives,” said Golfinkel.

Hormone therapy is taken in pill or patch form to manage these symptoms, she said.

But if you just want to treat localized symptoms, such as vaginal dryness, you can use topical lotions to administer hormone therapy, which won’t increase your risk of breast cancer, Golfinkel said.

The Canadian Cancer Society urges caution when considering hormone therapy for menopause.

“The Canadian Cancer Society advises women not to take HRT[hormone replacement therapy]for any reason other than to relieve symptoms of severe menopause when other treatments have failed,” the association said. It is stated on the website.

“If you and your doctor decide that taking HRT is right for you, you should use the lowest effective dose for the shortest time possible.”

Melinda Wu, M.D., general practitioner of oncology at Women’s University Hospital Breast Center, said the cancer society’s position is consistent with the findings of a review paper that all women should not receive hormone replacement therapy. He said they should be aware that hormone replacement therapy is an option to discuss. with their doctors.

“It always comes down to a risk-benefit discussion,” said Wu, who was not involved in the review paper.

“I think a lot of people appreciate the ‘less is more’ approach to medicine in general,” she says.

“We are treating something with the intention of understanding what benefit we are trying to achieve and then giving the lowest effective dose of menopausal hormone therapy to achieve that benefit. increase.”

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This report by the Canadian Press Agency was first published on May 15, 2023.

The Canadian Press’ health coverage is supported through a partnership with the Canadian Medical Association.