Hormone Therapy—Should I?

by Chrissie Seals, WHNP, Salud Spa

Menopausal women in transition endure dozens of symptoms — flushing, night sweats, vaginal dryness and fatigue are the four most common.

In the U.S., the use of hormones has been controversial. In France and England, hormone clinics have supported women for hundreds of years. These countries advocate for the treatment of menopausal women with hormones.

We are the only developed country at our level that essentially is against treating women with hormones long-term. The FDA recommends treating women with hormones for the shortest duration and at the lowest dose.

However, many hormone specialists in this country and others tout the many benefits of hormones, advocating a safer route of administration, careful selection of patients, and suggesting that bioidentical hormones may be preferred.

Advances include screening high-risk patients at risk for ovarian and breast cancer, making strides in prevention and proactive planning.

The safest modalities for hormone use in menopause:

  • Initiation of therapy within the first 10 years of menopause onset
  • Route of administration does not include orally
  • Bioidentical hormones instead of synthetic ones
  • Assessment of breast/ovarian cancer risk
  • Individualized plan of care with a clinical provider that specializes in hormones

In the 1990s, the Women’s Health Initiative trials released data that did not support the use of hormones. Women were included in these trials who perhaps should never have initiated hormones at their age, in their 70s and 80s.

When a woman begins having menopausal symptoms, usually about five years before menopause, the symptoms may be mild. The average age of onset of symptoms is 47.

Around 90% of women experience significant symptoms by age 52 that last approximately four years. A small number have early menopausal symptoms in their late 30s, entering menopause in their early 40s.

Hormones are essentially a key that travels through the bloodstream, affecting every function in the body. They target receptors that are like a lock, telling the organ or cells how to respond. Endogenous hormones are those the body makes within itself. Exogenous hormones are those administered.

The decision to take hormones in menopause must be an individual decision. Medical research supports cardiovascular benefits and prevention of bone loss in menopausal women treated with hormones. There has been no increased risk of breast cancer in women treated with estrogen alone in the first four years of use.

For many women, the decision to use hormones is about quality of life.