A recent series of articles, one published in the New York Times, have outlined the way that the risks and benefits of hormone replacement therapy for menopausal women have not been accurately represented. Prior to 2002, hormone therapy was widely prescribed for women. That was when the Women’s Health Initiative study raised concerns about the risks of hormone replacement. Since that study, the actual risks have been found to be much lower compared to the benefits. Despite that, many women still are not prescribed a treatment that could improve their quality of life.
Benefits of Hormone Replacement Therapy
All systems in the body are influenced by hormones including body temperature, heart rate, mood, sleep, and more. There really is no aspect of an individual’s health that is not in some way affected by hormone levels. Estrogen production decreases in women with age and can result in variety of symptoms. Replacing the lost estrogen with systemic estrogen therapy can help alleviate these symptoms. If the symptoms are localized to, for example, just the vagina then a more localized hormone therapy may be applied that is not systemic.
Hormone replacement therapy helps alleviate the uncomfortable, painful, and life-altering symptoms that occur when estrogen levels decline. Menopause is sometimes portrayed as only causing hot flashes – but many of the other symptoms can be worse. Sleep deprivation, urinary-tract infections, pain during sex, aching joints, depression, and more can be associated with declining hormone production. The majority of women in menopause will experience at least one of these symptoms. Besides relief of these symptoms, hormone therapy has also been shown to reduce bone loss and prevent fractures.
When Should Women Start Hormone Replacement?
A woman’s age when she starts hormone therapy is important in determining the risks of treatment. For healthy women in their 50s, the risks are relatively low compared to women who are over 60. Research to-date has shown that the benefits outweigh the risks for women when they start therapy sooner than later. The risks can be higher for women who have had significant health problems like a history of heart attacks or breast cancer. If a woman is trying to start hormone therapy much later in her 60s, doctors may advise against it or consider alternate therapies.
Are There Other Treatments for Menopausal Symptoms?
Hormone replacement therapy is definitely the most effective treatment for menopausal symptoms like hot flashes. However it is not the only treatment available. SSRIs and gabapentin for example, have been shown to effectively treat hot flashes. The drug ospemifene is used to treat pain during sexual intercourse. There are new drugs being researched that are non-hormonal and target the neuronal pathways that lead to hot flashes. While the hope is that something even more effective with fewer side effects is developed, for now the best option for most women is hormone replacement.
Hormone Replacement Forms
Hormone replacement therapy comes in a few different forms including creams, gels, oral forms, patches, and more. There are FDA approved forms of hormone replacement therapy available that are taken by many women, but are probably under-prescribed given the commonness of menopausal symptoms. Compounded hormone replacement therapy is sometimes prescribed when a different dosage is required, or a different combination of ingredients is needed. For example, a cream can be made that includes both estrogen and testosterone in one formulation. With compounding, any dosage of a hormone can be made – there are no set dosages that are set because each formulation is compounded for the individual patient.
Articles
Comparison of Gabapentin with Estrogen for treatment of hot flashes in post-menopausal women – Journal of Research in Pharmacy Practice
Menopause Treatment – Endocrine Society