Let’s dispel some myths…
First, a natural menopause transition, like pregnancy, is not a pathologic state; it is biologically normal. Hormone Therapy (HT) does not replace hormone levels which would naturally be low or not present post-menopause.
Understanding overall personal risk (individual and family medical history) prior to initiating systemic Hormone Therapy in menopause, or before, is crucial. For most the risk of drinking a glass of wine a day incurs a higher absolute risk of an adverse event such as breast cancer, or stroke than taking estrogen and progestogen Hormone Therapy, especially when initiated within 10 years of the final menstrual period or before age 60. Initiating therapy after 10 years of the final menstrual period is nuanced, and should be weighed in conjunction with symptom management, risk, and needed prevention (such as bone fracture and further bone loss).
Hormone Therapy should not be used for the following:
1) Prevention of dementia 2) Prevention of heart disease 3) Weight loss 4) To “prevent” the menopause transition
1a) Research suggests benefit exists for prevention of early dementia if Hormone Therapy is initiated after hysterectomy and or oophorectomy before menopause. For the general population, HT does not conclusively incur a preventive effect, more studies are needed. Some research suggests HT initiated after age 65, incurs a greater risk of dementia (Women’s health initiative memory study). Although this study was conducted with CEE (conjugated equine oral estrogen) and oral MPA (medroxyprogesterone acetate), a combination less used today.
2a) Initiating Hormone Therapy earlier in the menopause transition has a better risk profile for cardiac health than starting later in the transition or after age 65. More research is needed.
3a) Hormone Therapy does not aid in weight loss. It has a favorable effect on body composition, but weight loss often does not occur. Those using GLP-1 (glucagon-like peptide-1) medications may lose weight to a degree that it puts them at risk of bone loss, thus Hormone Therapy may be initiated to mitigate the risk of fracture.
4a) There is not enough evidence to suggest that Hormone Therapy initiated in perimenopause can prevent chronic disease or the menopause transition. It can be used to mitigate symptoms including hot-flashes and vaginal dryness.
https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf
Other information to consider…
Alternatives to Hormone Therapy exist for multiple symptom relief specifically hot flashes and dry vaginal tissues. A consult with a knowledgeable and compassionate provider can be of benefit.
A thickened uterine lining can occur if a woman is put on systemic estrogen therapy unopposed by not providing a way to keep the uterine lining thin, increasing the risk of uterine cancer.
Estrogen receptors are present in many tissues in the body. During the menopause transition the reduction of estrogen can have a profound effect on tissue function.
Hormone Therapy is not strong enough to prevent pregnancy or heavy menses during perimenopause.
Hormone Therapy options are weaker than contraceptive hormones used prior to menopause and often more bioidentical.
Hormone Therapy should be considered for: Prevention of bone fracture and bone loss; Prevention and treatment of vasomotor symptoms including hot flashes; and treatment of Genitourinary Syndrome of Menopause (symptoms often include dry vaginal tissues, irritation, frequent urinary tract infections)
In premature menopause (complete loss of menses) or primary ovarian insufficiency occurring at or before 40 years old—prescribing Hormone Therapy is therapeutic, considered replacement, and can aid in preventing a host of early pathologies; including: bone loss and fracture, early dementia, stroke, hot flashes and painful sexual penetration due to dry vaginal tissues.
Localized very low-dose vaginal estrogen Hormone Therapy can be initiated at any age (30-90 for example) to protect introitus and vaginal tissue function. Caveats exist for those who have a history of breast cancer. Alternatives are available for the very few who have contraindications, or those who desire not to use low-dose vaginal estrogen hormone.
More FDA approved Bio-identical options for Hormone Therapy exist than ever before. “Bio-identical” means different things to different people, but in general terms it means; identical to hormones your body produces. These hormones are sometimes initially derived from plants but must be chemically converted in a laboratory process to yield the active product you are then prescribed. This does not make them any less natural. You are not a plant.
