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Menopause and Hormone Therapy
Until July 2002, hormone therapy had been the standard therapy in the United States for treating menopause and its menopausal symptoms. Not only did hormone therapy relieve such discomforts as hot flashes and vaginal dryness, but it also seemed to protect against several postmenopausal conditions, such as osteoporosis and heart disease. But in July 2002, the Women's Health Initiative, a large, multitiered clinical trial sponsored by the National Institutes of Health, reported that hormone therapy actually posed more health risks than benefits for most women. And as the number of health hazards attributed to hormone therapy grew, doctors discontinued routine prescriptions for menopausal women.
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You might be wondering how this shift in opinion over hormone therapy affects you personally. In some cases, hormone therapy is still your best option for treating menopausal symptoms. In other cases, it might be wise to consider alternatives. Discuss with your doctor more about the specific risks associated with hormone therapy, and when you should or shouldn't take it, and what other treatments are available.
A turning point for Hormone Therapy.
Concerns about hormone therapy stem from the results of both the combined estrogen-progestin and the estrogen-alone arms of the Women's Health Initiative (WHI) clinical trial. The study population consisted of older postmenopausal women — the average age was 63 at the start of the trial. It's unknown whether the study findings can be applied to younger postmenopausal women.
For women taking the combination estrogen-progestin used in the study (Prempro), researchers found an increased risk of heart disease, breast cancer, stroke, blood clots and dementia. In addition, not only did hormone therapy increase the women's risk of breast cancer, it also made tumors harder to detect, leading to potentially dangerous delays in diagnosis.
For women taking estrogen alone (Premarin), preliminary results showed no increased risk of breast cancer or heart disease, but did find a slightly increased risk of stroke. Taking either estrogen-progestin or estrogen alone also didn’t prevent dementia or mild cognitive impairment (MCI), as was previously believed. Rather, the new data show a trend toward the development of cognitive impairment. Using hormone therapy to prevent dementia or MCI is no longer recommended for women 65 years of age or older.
Also among the accumulated study results, the WHI found that for women in the study, most of whom didn't have troublesome menopausal symptoms, combination hormone therapy didn't provide a meaningful improvement in such quality-of-life measures as sleep, emotional health, general health, physical functioning and sexual satisfaction. On the other hand, researchers did note a few benefits in the WHI study — including a decreased risk of osteoporosis-related hip fractures and fewer instances of colorectal cancer. Most experts now agree that hormone therapy isn't the therapy of choice for disease prevention in healthy older women. However, it may still have a place in treating some menopausal symptoms.
Who can benefit from hormone therapy?
Although the number of women who take hormone therapy is diminishing, for some — such as those who have severe hot flashes — the benefits of short-term hormone therapy may still outweigh the risks. Some women will say they just feel better on hormone therapy than when they are not.
"The absolute risk to an individual woman taking hormone therapy is quite low and may be acceptable to you in light of your symptoms," says Sharonne Hayes, M.D., cardiologist and director of the Women's Heart Clinic at Mayo Clinic, Rochester, MN. "Talk with your doctor about your personal risks."
Hormone therapy might still be your treatment of choice if you experience:
> Hot flashes: Hormone therapy is still the most effective medicine you can take for menopausal hot flashes and night sweats.
> Vaginal discomfort: Hormone therapy can ease vaginal symptoms of menopause, such as dryness, itching and burning. In this situation, consider estrogen vaginal creams.
> Osteoporosis: Hormone therapy continues to be an option for osteoporosis prevention, but it's recommended only when other medications for osteoporosis prevention have been tried or considered.
If you're already taking hormone therapy to relieve menopausal symptoms, you may need to rethink your options, especially if you are 5 or more years past menopause. "Consider the reason you started hormone therapy and whether the reason remains relevant," Dr. Hayes advises. "If you started hormone therapy for hot flashes several years ago, you may no longer have hot flashes and could stop taking the drug."
If you've taken a particular dose of estrogen, you may be able to lower the dose. Sometimes switching from an estrogen pill to a patch may offer benefits, since the patch doesn't affect blood-clotting factors the way the pill can. In treating vaginal symptoms, estrogen as a vaginal cream is usually a better choice than a pill or patch. If you opt for hormone therapy, take the lowest effective dose for the shortest amount of time needed to treat your symptoms.
Who should avoid Hormone Therapy?
Don't take hormone therapy for preventing memory loss, heart disease, heart attacks or strokes. Also avoid hormone therapy if you have a history of breast cancer — HT may increase your risk of this disease. Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.
Alternatives to Hormone Therapy
You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you try making changes to your exercise or eating habits first before you try medication. If after trying lifestyle modifications, you're still dealing with bothersome symptoms, you have several options besides hormone therapy to help relieve discomfort. Discuss them with your doctor.
Birth Control Pills.
Typically younger women will choose to take oral contraceptives (birth control pills) to regulate erratic periods, reduce menstrual cramps, or to prevent pregnancy. These pills use the same hormones found in menopausal hormones, though in smaller doses, but still carry some risks. For most women, the small relative risk is worth the convenience and effectiveness of birth control pills, but this decision should be made in conjunction with your doctor.
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