Latest Research on the Benefits and Risks of Hormone Replacement Therapy for Menopausal Symptoms

Estrogen is important!

Seize the key 10 years to improve menopausal discomfort and stay away from breast cancer, heart disease, osteoporosis and dementia

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Author: Avrum. Avrum Bluming, Carol. Carol Tavris

Publisher: Persimmon Culture

Editor in charge: Lai Yiling
Reasons for recommendation: To this day, the medical community still believes that “estrogens are the most effective way to treat women’s menopausal symptoms.” However, over the past 30 years, due to misunderstandings of hormone therapy and other factors, women’s health and quality of life have been seriously damaged during menopause, and the risk of heart disease, cardiovascular disease, and osteoporosis that comes with women’s menopause has also increased. Health risks are also significantly higher, and hormone therapy can actually be beneficial in reducing these risks and extending women’s lives.

Q1: I was not taking hormones when I entered menopause. Now that I am over 60 years old, can I start hormone replacement therapy?

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A sixty-three-year-old friend who had never received hormone replacement therapy called me to ask. She said, “I’ve been hearing you talk about hormone replacement therapy for a while and I want to go on hormone replacement therapy. It’s been six years since I went through menopause and I haven’t had any symptoms, but I’m worried about my memory, my heart condition, and my sex life. .Should I consider starting hormone replacement therapy now?”
This is a very reasonable question. My position is that if a woman uses hormone replacement therapy during menopause to deal with symptoms that seriously affect her quality of life, then as long as it is beneficial, there is no reason not to continue it for as many years as necessary; but, of course, under the supervision of a physician Follow instructions. But hormone replacement therapy is not something you can start when you want, stop when you want, and then continue again every few years. It’s not candy and it’s not vitamins. There is a window of opportunity, roughly defined as the ten years after a woman’s last menstrual period, when hormone replacement therapy is most effective when used during that period.
Taking hormone replacement therapy ten years into menopause may slightly increase the risk; if the woman has any pre-existing atherosclerosis problems, the therapy may further clog already narrowed arteries, at least while on hormone replacement therapy There is this risk in the first year. This risk can be assessed with tests to determine the health of your blood vessels and the strength of your heart. Therefore, I encouraged my friend to get these tests; she passed with good numbers and started hormone replacement therapy. It would make me uneasy to suggest that she take hormones without the above precautions.

Q2: Are there any other good ways to treat menopausal symptoms?

Menopausal symptoms may affect up to 80% of pre- and postmenopausal women, lasting an average of seven to 12 years. Although most symptoms will eventually disappear over time, symptoms related to vaginal atrophy, such as vaginal itching, burning sensation during urination, frequent urination, and pain during intercourse, will become more pronounced with age, and these symptoms often Can be successfully treated with topical estrogen vaginal creams.
Herbal remedies benefit 20% of women, but this success rate is no different than any placebo; the anti-epileptic drug Neurontin and the antidepressant drug Paxil reduce the rate by about 60% Hot flashes in women, but it does not help other menopausal symptoms such as joint pain, insomnia, heart palpitations, etc.
Of course, the medical community continues to search for successful non-hormonal treatments. In 2018, researchers at Imperial College London reported that a certain non-hormonal oral drug (NK-3 antagonist) could alleviate hot flash symptoms in women. Their study was small, with only 28 participants, but it was a randomized controlled trial and larger studies are bound to follow in the future.

Q3: Can’t I just take the lowest dose for the shortest period of time?

Although this is what all estrogen preparations say on their labels, there is little scientific basis for such advice and it seems to be a reluctant compromise on the part of some doctors who still believe that hormones are dangerous but also know that they can help many women. In its position statement on hormone replacement therapy, the North American Menopause Society advises clinicians to stop making such simplistic recommendations and instead tailor them to each patient’s needs, based on their age, time to menopause and other personal health issues. Consider the risks to prescribe the appropriate hormone dose and dosage form. The North American Menopause Society also agrees that there should be no “stop dates” or imposed limits on the length of time a woman can receive hormone replacement therapy. In addition, the Endocrine Society made the same recommendation in its 2010 scientific position paper.
This point cannot be emphasized enough. As I discuss in the book, for some conditions (especially osteoporosis and most likely cognitive decline), if a woman stops hormone replacement therapy, the benefits are lost. One woman involved in my breast cancer research told me that after ten years of taking hormone replacement therapy, her doctor advised her to stop treatment. The doctor said there was no evidence that hormone replacement therapy had any added benefit–but the doctor was wrong. As we mentioned in Chapter 4, older women lose bone mass more quickly when they stop taking hormones; after six years, their bone loss is the same as that of women who had never taken hormones.

Q4: How should I view and determine whether my symptoms are suitable for hormone replacement therapy?

If you are in premenopause or menopause and are considering hormone replacement therapy to improve your quality of life, start by reviewing the symptoms listed at the beginning of Chapter 2.
In addition to common symptoms such as hot flashes and night sweats, it’s also important to be aware of other symptoms you wouldn’t normally associate with menopause, such as joint pain, heart palpitations, headaches, insomnia, and more. Ask yourself: “How severe is each symptom? How much does it affect a woman’s quality of life (not at all, tolerable, terrible, or intolerable)?” When a physician or researcher evaluates a woman’s quality of life , and ask her to roughly describe her overall condition (“How is your physical and mental state? How is your mood? How is your health?”), it usually leads women to think “I should endure rather than complain”, but does not really Find out which specific symptoms or issues are bothering women.

Q5: Is there any difference in which estrogen dosage form is used?

I know many women on hormone replacement therapy who use the patch rather than the pill, so they often ask me if it matters. They usually use the patch because their gynecologists have told them it is “less harmful,” meaning the risk of blood clots is not that high. That’s true, but what they don’t say is that the patch’s “benefits are not that great.”
Not all forms of estrogen are equally effective at improving, say, cognitive function or reducing the risk of heart disease; oral forms appear to be more effective than the patch in preventing cardiovascular disease and stroke. Roberta. Brinton and his colleagues have been studying estrogen and brain functions related to Alzheimer’s disease for many years. They found that an estrogen only contained in premarin is equilenestron, which stimulates the cortex and other brain areas. Neuronal growth in the region.

Q6: Will progesterone cause problems?

For years, it was believed that estrogen put menopausal women at higher risk of breast cancer. Now, we know that’s not the case; estrogen can even reduce that risk. As a result, people’s attention shifted to the possible harm caused by progesterone. Based on the observations of any study to date, women taking estrogen combined with natural micronized progesterone do not increase the risk of breast cancer. Although I disagree, some researchers believe that synthetic progestins slightly increase the risk of breast cancer, but even so, the increase is less than 2 percent. And even though hormone replacement therapy increases the risk of breast cancer by a small amount, we should also remember that women who receive hormone replacement therapy live longer on average than women who do not receive hormone replacement therapy.

Q7: Is hormone replacement therapy really risk-free?

Hormone replacement therapy does have some risks, but they are mostly minor, such as dry eyes (which, oddly enough, is one of the symptoms of menopause itself). Some women experience migraines during menstruation, and taking estrogen may cause migraines to return during menopause.
Some risks are more serious, such as gallbladder disease and venous blood clots, according to the U.S. Preventive Services Task Force. But just like Roger. Robert’s conclusion: “Many of the negative effects are not fatal and can be managed by adjusting the dosage and form of hormone replacement therapy. Such effects include breast tenderness, abdominal bloating, mood swings, uterine bleeding, and the possible effects of oral estrogen. Abnormally elevated blood pressure, etc.”
He pointed out that more serious problems may occur, such as venous thrombosis (blood clots in the veins traveling to the lungs), but in healthy women entering menopause, “the risk is very small and no more serious than those who receive a placebo treatment.” People are significantly higher…Available data show that hormone replacement therapy does not increase risk or cause serious negative effects.”
A growing number of professional organizations support Robert’s conclusion, arguing that the benefits of hormone replacement therapy to the heart, bones, brain, and lifespan far outweigh the risks. In 2013, the British Menopause Society and Women’s Health Care recommended that there should be no arbitrary limits on how long women can use hormone replacement therapy. Their statement states that if symptoms persist, “the benefits of hormonal therapy generally outweigh the risks.”

Editor/Photo by Lai Yiling/Yang Shaochu