From stopping hot flashes to renewed sex drive, hormone therapy promises to turn back the hands of menopausal time, but is it both safe and effective?
Hormone therapy is the use of medications to replace female hormones, primarily estrogens, as the body stops making them after menopause. Estrogens are commonly referred to as female sex hormones, and they are important for the sexual and reproductive development of women.
Hormone therapy attempts to replace the hormones lost after a woman reaches menopause, which can cause a series of uncomfortable symptoms like hot flashes, night sweats, decreased sex drive, depression and mood swings. While these symptoms often develop after women go through menopause naturally, the loss of normal ovary function from a hysterectomy (surgical removal of the uterus) can also trigger these symptoms.
How can hormone therapy help?
There are two forms of hormone therapy that have different benefits depending on the patient’s needs. These forms are systemic hormone therapy and low-dose vaginal products.
Systemic hormone therapy — which can be administered by pill, skin patch, gel, cream or spray — is considered the most effective treatment for hot flashes and night sweats. Systemic hormone treatment may also help with vaginal dryness and itching as well as discomfort during intercourse.
Low-dose vaginal products are available in cream, tablet or ring form to treat vaginal symptoms. Low–dose vaginal products allow the body to absorb minimal amounts of estrogen to treat symptoms like vaginal dryness and itching, but have no effect on hot flashes or night sweats.
The U.S. Food and Drug Administration (FDA) approves of the use of systemic hormone therapy to help prevent osteoporosis, a bone-thinning disease most common in women, but it is more common to use other medications to treat this condition. Low-dose vaginal products provide no protection from osteoporosis.
What are the risks associated with hormone therapy?
Recent, large studies, including clinical trials from the Women’s Health Initiative (WHI), on the use of a combination estrogen-progestin pill (Prempro) revealed a greater risk of several serious conditions, including heart disease, stroke, blood clots and breast cancer.
Related studies from the WHI and others have shown that estrogen (Premarin) alone did not raise the risk of breast cancer and heart disease in women who had a hysterectomy. The increased risk for stroke and blood clot remained, however.
The American Academy of Family Physicians (AAFP) “recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women.”
In addition, the AAFP “recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.” These conditions include osteoporosis and invasive breast cancer.
The risks associated with hormone therapy vary greatly depending on factors that include current age and age at menopause, dose and type of estrogen as well as family medical history. These risks need to be evaluated when considering hormone therapy.
How can one reduce risks related to hormone therapy?
Hormone therapy comes in many forms, including pill, patch, ring, cream and gels to meet the needs of most patients. If your menopause symptoms are primarily vaginal, low-dose estrogen in vaginal cream, tablet or ring is generally the best option for treatment.
"Hormone replacement therapy has historically been an instrumental part of treating women as they approached menopause and beyond," Andre F. Hall, MD, an OB/GYN at Birth and Women's Care, PA in Fayetteville, NC, told dailyRx News.
"The Women's Health Initiative, which was a large study done to evaluate the safety of these medications, raised serious concerns as to whether these medications should be used over long periods of time and whether they increased the risks of certain cancers. That question has not been definitively answered, and we know that for many women their qualify of life is significantly diminished without these medications," Dr. Hall said.
"The current recommendation is that women who need these medications for symptomatic relief should be on these medications at the lowest dose for the shortest amount of time needed to relieve the symptoms," he said.
Work with your doctor to determine the lowest effective dose that relieves your symptoms and the shortest period of time to remain on hormone therapy. The lower the dose and the shorter the time you take the medication, the better.
Maintain a healthy diet, limit alcohol and work with your doctor to manage health conditions like high cholesterol and high blood pressure. Making healthy lifestyle choices lowers your overall risk for many common ailments, not just those associated with hormone therapy.
Discussing your menopausal symptoms with your doctor is the best way to determine if hormone therapy is right for you. The symptoms and their severity can change often, making regular checkups a priority to ensure the best treatment and outcome for you.