By Patricia McLelland, M.D.
In recent years, medical information about menopause and hormones has changed rapidly and many women are confused. Before 2002, hormones were the standard recommendation for most women who were going through menopause to help with symptoms and to decrease the risk of certain diseases (heart disease and osteoporosis).
In 2002, The Women's Health Initiative (WHI) published a study on Premarin (a type of estrogen) and Provera (similar to progesterone) that revealed an increased risk for heart disease, stroke, blood clots and a slightly higher risk for breast cancer. This caused significant anxiety in women who were on hormone therapy as well as the providers prescribing hormones.
Unfortunately, the risk was not put in context so that women could see if these risks applied to them. Full discussion of these studies is beyond the scope of this article; however there are several facts about the study that should be addressed. First, the average age of women in these studies was mid- to late-60's and these women had no symptoms of menopause (hormones are not typically recommended to women in this age group who do not have symptoms).
Second, the risk of heart disease was only significant in the first year of taking the hormones. Third, the small increased risk in breast cancer, based on both studies may be mostly due to Provera (the WHI study on Premarin alone showed no increased risk of breast cancer when Provera was not used).
There is disagreement among experts on whether or not information based on one hormone preparation should be applied to all hormones. Some experts feel that the information should apply to all women (no matter what their age) and to all types of hormones.
Since women experience menopause differently and since each person has different disease risks, it is impossible to make a single recommendation about all hormones for all women.
Who should take hormones? Most doctors today agree that the primary reason for taking hormones are for the symptoms of menopause.
As a general rule, hormones should not be used just to prevent diseases. The most common symptoms include hot flashes, night sweats, vaginal dryness and mood swings. Symptoms affect women differently so most women will consider hormones if their symptoms are significantly affecting their quality of life.
There are lifestyle changes that I reviewed in an earlier article that may help many women. There are also non-hormonal medications including Effexor, Prozac, Neurontin, and Clonidine that decrease certain menopausal symptoms. These medications are not for everyone.
The decision for women to try hormones is often difficult. Many women are looking for options that are lower risk. These include different ways to take hormones (for example, hormone patches or creams) and different types of hormones, for example, bio-identical hormones (the hormones used are the same that a woman makes before menopause).
If the choices are confusing, consultation with her physician is of course recommended. In my experience, on an individual basis most women can decide what is right for them. They need to decide based on their own health risks, their family history, their severity of symptoms, and their personal fears.
Patricia McLelland, MD, board certified in obstetrics, and gynecology, is currently a practicing physician at Galen OB/GYN in East Brainerd, TN. She received her medical degree in 1994 from the Vanderbilt University School of Medicine in Nashville, TN. She has been a member of the Chattanooga & Hamilton County Medical Society since 2004.
She can be reached at: 1651 Gunbarrel Road, Suite 201, (423) 899-9133.