Is hormone replacement therapy safe for menopausal women?

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Every woman will become menopausal if she lives long enough. Menopause is a process that’s often misunderstood, but there are plenty of options for making a woman feel better during this time in her life.

I enjoy educating women about menopause and all of the options available to help make that time of transition much more comfortable. It’s one of the most rewarding aspects of my job, because this time can be the best in a woman’s life, if managed properly.

But the best way to help women going through menopause isn’t clear. Hormone replacement therapy was once thought to be the Holy Grail method for treating symptoms in menopausal women. Middle-aged women could quell their hot flashes and feel comforted knowing they were simultaneously preventing chronic health diseases by wearing a patch that delivered estrogen and progesterone to their hormone-depleted bodies.

Earlier this decade, however, the Women's Health Initiative challenged physicians’ way of thinking. We learned hormone replacement therapies not only didn't prevent chronic diseases, such as stroke and breast cancer, they actually might increase the risk for cardiovascular disease in older postmenopausal women.

Let’s look at some of the most pertinent topics concerning menopause and how we can make this time of life rewarding for all women.

What is menopause?

Menopause is the reverse image of adolescence. It’s a period in a woman’s life when a natural decline in reproductive hormones takes place. Time wise, it’s measured as one year following a woman’s last period.

There’s a transition between menopause and the time just before, which is referred to as perimenopause. More simply, some refer to it as the menopause transition. During this period, women could experience changes in their monthly cycles, hot flashes, fatigue, weight gain or tenderness in their breasts.

The transition usually takes place between the ages of 45 and 55, ranging from seven to 10 years or more. The two main hormones that decline are estrogen and progesterone, both produced by ovaries.

Surgical removal of both ovaries could initiate menopause more abruptly. Women who have this procedure will usually experience menopausal symptoms if they’re not taking hormones.

Why treat hot flashes?

It’s one of those things – your mom and grandma did it. But do we really have to just suck it up and make it happen? You’re not your mom or your grandma. Women today are busy, active, often at their peak of their careers. We need to feel good. Women can’t just sit on the couch and let hot flashes come and go.

I said this time can be the best in a woman’s life. By that, I mean it’s a time many women can do what’s fun for them. They’re no longer trying to climb the ladder of success, they don't have periods and the days of rearing young children are likely in the past. For many, it’s time to refocus on their lives.

Is hormone replacement passé?

You might be surprised to learn that I still readily prescribe hormone-replacement therapy to women as a short-term option for treating hot flashes in menopause, and to prevent osteoporosis. I think hormone therapy is a good, underused treatment option from which far more women could benefit.

Hormone therapy is a good treatment for hot flashes in the short term, five to seven years, depending on the duration of hot flashes. Hormone therapy replaces natural hormones and works in an area of the brain that helps reduce hot flashes.

The therapy can prevent osteoporosis by slowing down bone loss, which often happens during menopause.

It’s controversial if hormone therapy is helpful for other menopause symptoms, including difficulty sleeping, concentrating, incontinence and vaginal dryness. There are other treatment options for these symptoms.

After the hot flashes go away, reevaluate hormone therapy as a treatment option and use another first-line prevention for osteoporosis.

For those unwilling or unable to take hormone therapy, other good medication options exist to help with hot flashes.

Postmenopausal women have a higher risk of dementia, cardiovascular disease and osteoporosis. Thus, it’s vital that post-menopausal women eat well, exercise, and increase calcium intake to promote strong bones.

Cynthia Evans is an obstetrician and gynecologist at The Ohio State University Medical Center who specializes in treating menopausal women. She’s also a Certified North American Menopause Society practitioner.