Is Hormone Therapy a Safe Way To Treat Menopause Symptoms?

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Most women have heard about menopause, but what exactly is it? Menopause occurs when a woman outlives her ovaries’ ability to produce an egg. When this happens -- and it is a normal occurrence -- a woman loses 90 percent of her estrogen.

This loss of estrogen is responsible for many bothersome menopausal symptoms. One of the most common is hot flashes, also known as vasomotor symptoms. Hot flashes occur in 75 percent of menopausal women and can range from mild to extreme, negatively affecting a woman’s quality of life.

The most effective option for treatment of hot flashes is hormone therapy, which is sometimes called hormone replacement therapy.

Hormone therapy consists of estrogen and the addition of progesterone if a woman still has her uterus. However, many women and providers are concerned about the safety of menopausal hormone therapy.

Benefits Can Outweigh the Risks

Hormone therapy received a lot of negative media attention after the very public results of the 2002 Women’s Health Initiative (WHI). The WHI did find an increased risk of stroke, heart attack, blood clots and breast cancer with hormone therapy, but what is not well-known is that the average age of the participant was 63 and had not been on hormone therapy since menopause.

The North American Menopause Society (NAMS) put out new guidelines in 2017 saying that for most women with bothersome menopausal symptoms, the benefits of hormone therapy outweigh the risks in women less than 60 years old or within 10 years of being menopausal.

Furthermore, for women who use transdermal estrogen instead of oral estrogen, there is even less risk of a stroke or heart attack due to a blood clot.

There is an increased risk of breast cancer with hormone therapy, but that risk is less than 1 in 1,000 women and doesn’t occur until a woman has been on hormone therapy for 3-5 years. In addition, there is no increased risk of cancer in the lining of the uterus when a woman uses adequate progesterone.

Currently, the Food and Drug Administration (FDA) approves the use of hormone therapy for treating hot flashes and vaginal dryness and preventing osteoporosis. But other benefits of hormone therapy may include help with negative mood changes, better sleep quality and alleviating "brain fog.”

Jean Marino MSN, APRN-CNP, NCMP, IF, is a women’s health nurse practitioner with UH OB/GYN & Women's Health.

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Board-certified gynecologists, certified nurse practitioners and women’s behavioral health specialists at University Hospitals offer expert care, education and support for women throughout all stages of menopause. Learn more about menopause management services at University Hospitals.

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