Menopause Mystery Series - Hormone Therapy is Dangerous
Myth Number 2 on the dangers of hormone therapy (HT) is next in the Menopause Mystery Series that covers myths of menopause I have seen working with women over the last 12 years. Let’s be clear, this article focuses on risks and myths I’ve seen/heard and does not cover many of the benefits so don’t let it scare you off.
Let’s explore how we got here before we get into the details of risks. There has been so much confusion, and honestly FEAR, around hormone therapy for the last 20 years. This fear in many ways started from data from the Women’s Health Initiative (WHI), a long-term national health study that began in the early 90’s and was abruptly halted in 2005. Data from the study was presented in a way that caused complete panic and is still affecting providers decision to treat menopausal women even today! You see it in the form of recommending treatment only for women with the most severe symptoms. Or, even just tough it out. I see this daily in my current practice where the only options offered are waiting it out or offering antidepressants. Yes, antidepressant can be a non-hormonal treatment option and I will cover those options in another segment. And see Myth 1 for more on just waiting things out.
First, there were a few problems with the study but as a result did provide some good data. The average subject age of women in the WHI study was 63 years old. The risk assessments that were conducted for safety were based on women in their 70’s. The women in the study were using high dose synthetic hormones. Note, today, we use lower dosages and formulation of hormones, not synthetic, than were used in the WHI trials. New formulations are much closer to the hormones that the body would naturally make on their own. We also have better delivery routes including delivery through the skin which bypasses the liver and almost eliminates the risk of blood clots which was one of the risks identified in the study.
But, one of the most important things that we learned from this study is the timing of therapy. This is referred to as the estrogen window which is that period of time when women are 60 years or younger or who are 10 years from beginning menopause. The estrogen window is a crucial period where if you are suffering from menopause it can be important to get help. Outside of this window, there are most definitely risks associated with some of the treatment options.
“For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome VMS and prevention of bone loss. For women who initiate hormone therapy more than 10 years from menopause onset or who are aged older than 60 years, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.” (The North American Menopause Society, 2022)
The WHI was not focusing on women in their 40’s and 50’s who are the women who would normally be seeking menopausal care. It really is unfair to deny women treatment options when the data in the study is not representative of their age group and the formulations used today are known to be safe, effective and in many ways provide benefits that outweigh many of the risks.
The added risk for blood clots, stroke, and breast cancer with the treatment options we have today is also very low. One of the biggest questions surrounding Menopause Hormone Therapy (MHT) is breast cancer risk. There are many variables and layers to this. This is a bigger question to discuss with your healthcare provider. However, below are some of the key points taken from the NAMS positions statement on hormone therapy related to breast cancer risk:
“The risk of breast cancer related to hormone therapy use is low. Less than one additional case per 1,000 women per year of hormone therapy use or three additional cases per 1,000 women.” (The North American Menopause Society, 2022)
“Women should be counseled about the risk of breast cancer with hormone therapy, putting the data into perspective, with risk similar to that of modifiable risk factors such as two daily alcoholic beverages, obesity, and low physical activity.” (The North American Menopause Society, 2022)
“The effect of hormone therapy on breast cancer risk may depend on the type of hormone therapy, duration of use, regimen, prior exposure, and individual characteristics.” (The North American Menopause Society, 2022)
“Different hormone therapy regimens may be associated with increased breast density, which may obscure mammographic interpretation, leading to more mammograms or more breast biopsies and a potential delay in breast cancer diagnosis.” (The North American Menopause Society, 2022)
“Regular breast cancer surveillance is advised for all postmenopausal women per current breast cancer screening guidelines, including those who use hormone therapy.” (The North American Menopause Society, 2022)
So, finally!!! Menopause and suffering women are getting much needed attention. Newer research is uncovering some of the misconceptions and faults with the WHI study and there are treatment options for women that are safe. MHT is the most effective treatment for hot flashes and night sweats. MHT has been shown to increase quality of life, improve sleep and mood. For women 60 years or younger whom have bothersome symptoms and are within 10 years of menopause the benefit of therapy generally outweighs the risk.
These visits do take time and are often more complex than the standard 15 or 20-minute appointment. Checking in on emotional and mental health is just as important as checking in on physical symptoms. Decisions on hormone therapy should be made based on risk factors of each individual women. It is not for everyone and there are very few women that completely risk out of hormone therapy. If you are experiencing menopausal symptoms, I would encourage you to seek out a provider with experience in menopausal care to help you. And, of course, if you’re residing in Idaho I can help. If you’re interested in learning more schedule an appointment or contact us today.
References
The North American Menopause Society. (2022). NAMS Position Statement. The Journal of the North American Menopause Society. Retrieved December 29, 2023, from https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf
Disclaimer
Yes, I am a women’s health nurse practitioner and an expert in the field of menopause. This blog post is not intended to be used as medical advice. This content is intended to be for informational purposes and should not be a substitute for medical advice. Please consult with your healthcare provider regarding your own personal situation.
