Menopause is a normal, natural life event occurring between ages 40 and 55. Most women think that they go through the menopause and it is over but it actually is a life stage that is defined after 12 months without a menstrual period. Some women may reach menopause early (before age 40), because of surgical removal of the uterus and ovaries, chemotherapy or medical treatment, or natural causes. The management of these early menopause cases is unique and different from so-called natural menopause.

Each woman will experience menopause in her own unique way. Some women may not experience any symptoms affecting their quality of life. However, for many women, the most common bothersome symptoms are hot flashes, night sweats, and vaginal dryness. The most effective treatment for these symptoms is hormone therapy (HT).

HT commonly refers to two different options:

  • If you have a uterus, you may be prescribed combination estrogen plus progestin therapy (EPT). The progestin is added to protect your uterus from cancer that can occur when estrogen is used alone. If you are prescribed a low dose vaginal estrogen for treatment of vaginal dryness, you probably will not be prescribed a progestin.
  • If you do not have a uterus, you will need only one hormone, estrogen (ET).

There are many HT options available by prescription from your healthcare provider:

  • a pill is taken by mouth
  • a patch, cream, gel, or spray that can be applied to your skin
  • a cream, suppository, tablet, or ring that can be used within the vagina.

Many doses are available to meet your needs. Each of these options has different pros and cons that you can discuss with your provider.

Bioidentical hormones, which are similar to the hormones made by the ovaries, are available in well-tested, government-approved brand name products that can be prescribed by healthcare providers. The term  ”bioidentical hormone therapy” is also often used to describe custom-compounded hormones that are obtained at special compounding pharmacies. They are not government-approved, have not been tested for effectiveness, safety, consistency of dose, or purity (absence of contaminants)..  Although government-approved bioidentical hormones are a good option for many women, custom-compounded hormones are not recommended unless you have an allergy to approved products.

In 2002, a large study called the Women’s Health Initiative (WHI) reported an increased risk of breast cancer, heart disease, stroke, and blood clots with the use of EPT. In the ten years since the reporting of those results, we have learned that type of HT (ET versus EPT), how it is taken, and the timing of starting this treatment (early versus late after menopause) produce different benefits and side effects. The risk of side effects (such as heart attack, stroke, blood clot, or breast cancer) with HT in healthy women ages 50 to 59 is low. In contrast, using HT a long time or starting HT when you are several years beyond menopause, is associated with a higher risk of all of those side effects.

The North American Menopause Society’s (NAMS) released a new Position Statement on Hormone Therapy to help understand the accumulated data we have over the past 10 years. Here is what we now know:

  • HT remains the most effective treatment available for menopausal symptoms, including hot flashes and night sweats that can interrupt sleep and impair quality of life. Many women can take it safely.
  • If you have had blood clots, heart disease, stroke, or breast cancer, it may not be in your best interest to take HT. Be sure to discuss your health conditions with your provider.
  • How long you should take HT is different for EPT and ET.  For EPT, the time is limited by the increased risk of breast cancer that is seen with more than 3 to 5 years of use. For ET, no sign of an increased risk of breast cancer was seen during an average of 7 years of treatment, a finding that allows more choice in how long you choose to use ET.
  • Most healthy women below age 60 or within 10 years of menopause will have no increase in the risk of heart disease with HT.  The risks of stroke and blood clots in the lungs are increased but, in these younger age groups, the risks are less than 1 in every 1000 women per year taking HT.
  • ET delivered through the skin (by patch, cream, gel, or spray) and low-dose oral estrogen may have  lower risks of blood clots and stroke than standard doses of oral estrogen, but all the evidence is not yet available. Research will continue to bring valuable information to help women with their decision about HT.

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