Hormone therapy has a controversial history, mainly due to a large research study done in 1993 called the Women's Health Initiative. This study aimed to determine the risks and benefits of hormone therapy in post-menopausal women overtime. The study was concluded early due to the researchers finding higher incidences of cardiac events and breast cancer among women using hormone therapy. From there, hormone therapy was labeled as harmful for women and was put on the backburner for treatment of vasomotor symptoms during menopause.
More recently our ideas of hormone therapy for the treatment of menopause has changed. We've now adopted hormone therapy as the gold standard treatment for vasomotor symptoms of menopause.
You may be wondering, 'what changed?'
Going back to the Women's Health Initiative study we saw that there were many flaws that led to bad results.
The first was the age of the participants and the time from their last menstrual period. Most of the women participating in the trial were over 65 years old and had not had their period within the last 10 years. We have seen since then that the risk versus benefit of hormone therapy really varies with a women's age. Patients under 65 years old who have had their last menstrual period within the last 10 years are not at an increased risk for cardiac disease or breast cancer.
The second was the form of estrogen used. There are various forms of estrogen and how they are taken. In the Women's Health Initiative, estrogen was given in the form of conjugated equine estrogen, orally. When this form of estrogen is taken orally it must go through the liver to be processed, resulting in a form of estrogen that is more harmful for the body. We have seen since that if we use estradiol or estriol topically instead of orally, the liver is not involved, and the harmful form of estrogen is not made.
The third is accounting for lifestyle factors and other contra-indications. Many of the participants that were tested in the study were smokers. Smoking is considered a contra-indication for hormone therapy. When we account for the personal risk factors and contra-indications for each patient, we can determine if they are considered in a risky group for this form of therapy.
The truth is that hormone therapy can be very beneficial for the treatment of menopause. Its been shown to have excellent results for hot flashes, vaginal dryness, insomnia, low libido, and it can help to improve body composition and reduce the risk of dementia, osteoporosis and cardiovascular disease when used in the correct population.
The most important thing to do when considering treatment with hormone therapy is to be evaluated by a knowledgeable practitioner. We see hundreds of women for menopause in our clinic and would be happy to help.
Want to know if hormone therapy is right for you? Book your free 15 minute call today to learn more
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