“But they’re real risks. They’re life-altering
events (stroke, heart attack, breast
cancer), and they can be serious.”
The hormones studied in the WHI were
oral therapies providing “systemic” levels
of hormones throughout all the body’s
systems. These medications are proven to
be effective for treating most menopause
symptoms, including hot flashes and
vaginal dryness. However, if vaginal
dryness is the only reason for considering
hormone therapy, local estrogen therapy
applied inside the vagina is the best
choice. Nothing else works as well—and
risks are thought to be minimal.
A Personal Decision
The decision to use hormone therapy,
to try an alternative, or to simply adopt a
healthy lifestyle and wait out menopause
symptoms with no treatment, is highly
personal. Each woman needs—and
deserves—individualized care, not a
blanket one-size-fits-all prescription.
Although healthcare providers continue
to learn more about the effects of
hormone therapy on groups of women,
they will never know the complete impact
for each individual. What’s important is
that you make your decision fully aware
of what is known about any potential
consequences and what is uncertain.
“What you choose should be based
upon your health, symptoms, lifestyle
concerns, and discussions with your
healthcare provider about the pros and
cons, as they apply to you,” says Marcie K.
Richardson, M.D., director of the Harvard
Vanguard Menopause Consultation Service
in Boston. “I say to women, ‘These are what
the benefits might be. These are what
the harms might be. How scary are these
harms to you? How important are these
benefits?’ If the potential benefits outweigh
the potential harms, then a trial of hormone
therapy—starting with a low dose—has
very little downside for most women.”
It’s worth remembering the effect of
hormones on your bones. After menopause,
without using systemic estrogen,
bone strength falls off rapidly. Long-term
estrogen therapy helps keep bones strong,
but its associated risks limit its use for this
purpose alone.
Time to End the Hormones?
As you progress into menopause and
your symptoms subside, reduce or stop
hormones as appropriate and in consultation
with your healthcare provider. If
symptoms persist, hormone therapy can
be resumed.
In Richardson’s practice, women had
a wide range of experiences when they
ended hormone therapy after WHI.
“Some went off and didn’t notice much
of a difference. Some went off and had
horrendous symptoms.” Some even had
worse symptoms after stopping the
medication than when they first started
taking it, she adds.
Richardson advises her patients to
taper off, although she admits there
is few data on whether this limits
symptoms. “If a woman doesn’t want to
go back on estrogen, I try to help her
find alternatives,” she says. “If someone’s
symptoms are making her miserable, and
she understands the potential risks, I help
her go back on hormones, identifying the
lowest dose that provides enough relief
of symptoms to make her comfortable.”
Hot flashes generally end eventually,
usually a few years after menopause is
reached, although sometimes they go on
longer. Vaginal dryness can continue to
worsen as women age. As you progress
beyond menopause and your symptoms
subside, it may be time to rethink your
options—again.
menopause & health
Bioidentical
Hormones
When scientists and
healthcare providers talk
about “bioidentical” hormones,
they’re usually referring to
products that are chemically
identical to those produced
by premenopausal women,
such as 17 beta–estradiol or
progesterone. Some bioidentical
hormones made by drug
companies are available in FDAapproved
products.
Bioidentical hormones are
also available as customcompounded
formulations,
sometimes referred to
as BHT (bioidentical
hormone therapy), and are
usually prepared at special
compounding pharmacies.
These individualized doses and
combinations of hormones are
based on a healthcare provider’s
prescription. But compounded
formulations have not been
tested for effectiveness and
safety, and custom-made
prescriptions are not approved
by the FDA. In fact, the FDA
recently issued warning letters
to many of these pharmacies
forbidding them from making
false and unsupported claims of
effectiveness and safety of their
BHT products.
Further research is needed
to establish the benefits and
harms of BHT, as they have
not been proven to be safer
than FDA-approved hormones.
And both the North American
Menopause Society and the
Endocrine Society have issued
statements that there isn’t
yet enough scientific evidence
to support claims that there
is an increased efficacy or
safety of custom-compounded
formulations, including BHT.
It is recommended that before
you decide to start BHT that
you speak with a qualified
healthcare provider to discuss
your options.
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