One of my all-time favorite websites that explores women’s health from a woman’s perspective is Women’sHealth. I look to it for information and guidance on many aspects of my life and have almost always found that they speak about the same issues that affect me in easy-to-understand terms without talking down to their readers.
That’s why I got an extra boost when I opened their latest circular in my email inbox and read the heading of their article titled “Hormone therapy was villainized for decades, but now, it’s back.” That immediately made me feel like getting up and dancing around the kitchen. My positive reaction came as a result of the endless stream of derogatory comments that most other sources have poured over the whole concept of treating the symptoms of menopause with hormone replacement.
For me, the problems I experience after the transition into menopause aren’t simply attributable to a passing phase that is due to go away any day now. I’m in it for good! As well, the “known facts” that lead so many observers to conclude that menopause is just something you have to live with are simply unacceptable. They rank up there with past attitudes that condemned treatable diseases to be merely another fact of life that people had to live with. People suffered and even died from cystic fibrosis, hepatitis, tuberculosis, peptic ulcers, and most recently and remarkably, HIV/AIDS. The same attitude applied to them, leaving them in misery and pain, as it does for me and other women who experience the worst effects of menopause. At least for the others I mentioned, there was a concerted effort to find, if not a cure, at least a way to alleviate the suffering and extend the people’s life expectancy. For some reason, instead of there being a movement towards finding some way to improve the lifestyle of women experiencing the negative effects attributable to menopause, there was a conscious push to say something like, “There’s nothing we can do, so just get over it.”
The most obvious part of that push came in the movement to downplay hormone replacement therapy as a viable approach to menopause. It reached its peak just after the start of the current century, primarily caused by the findings in a massive double-blind trial into the possible negative side effects of estrogen therapy. There’s too much background data for me to be able to summarize it here, but in short, the findings were that treating menopausal women with estrogen plus progesterone raised the risk of heart attack, stroke, deep vein thrombosis, and some cancers. At the same time, it reduces the risk of fractures from falls. As a result, the FDA issued an instruction that all estrogen treatments must carry a “black box” warning about these elevated risks.
My life in menopause
I know that many women are lucky enough to breeze through the transition into menopause with barely a hiccup. But for me, and many of my contemporaries, menopause was not just a few months of hot flashes and night sweats. I’ve now been experiencing many problems since menopause set in, including difficulty in sleeping and brain fog as primary symptoms, which have affected my waking hours and my performance as a breadwinner. I don’t even want to go into the “personal” areas like loss of libido and sexual discomfort coming from vaginal dryness.
Right after menopause began for me, I asked my friends for advice based on their own experiences. They fell mainly into two camps. On the one hand, some had indeed been the “lucky ones” for whom the transition had been swift and who no longer experienced serious effects. Sure, they sometimes felt a bit “offish,” but that was something they could live with. Others were like me, having had their symptoms not only persisting but, in many cases, growing steadily worse over the years. Most of them had heard about hormone replacement therapy but were scared to try it and had those fears reinforced when they spoke to their healthcare providers. The sad story in the case of menopause is that there are very few alternatives or at least none, that work as well.
A quick diversion into HRT – its workings, effects, and side effects
Hormone replacement therapy works on the established principle that as women pass out of the fertile years (generally between the ages of 45 and 55), there is a steep decline in their body’s production of two hormones, estrogen, and progesterone, which are key players in the menstrual cycle. HRT is based on the concept that keeping the levels of estrogen high can help a woman avoid the effects of estrogen depletion, which are the symptoms of menopause. These run through a whole gamut of effects, from mild to life-changing, and each woman can and does experience them differently.
When some form of treatment (HRT or something else) is not being administered, many symptoms are possible. The most common include:
- Hot flashes
- Night sweats
- Dryness in the vagina and vulva, coming from vulvovaginal atrophy
- Increased occurrence of urinary tract infections (UTIs) due to a thinning of the urethra
- Painful sex due to a lack of vaginal lubrication and thinner linings of the vagina
- Decreased bone mineral density, which can eventually lead to fractures coming from osteoporosis
- Depression, sleep disturbances, mood swings, reduction in levels of attention, and fatigue.
- Lower sexual desire
- Accelerated skin aging
- Joint pain
- Irregular or absent periods (during perimenopause)
- Breast tenderness
- Headaches or more frequent migraines
Hormone Replacement Therapy is prescribed with the expectation that the benefits are greater than any associated risks. As I started by saying, in the early years of the current century, it was felt based on the results of an extensive study that the risks of cancers, heart failure, and stroke outweighed the benefits, which led to the FDA’s issuing of a black box warning and the drop in prescribing. I feel this was mainly driven by the authorities’ (and the prescribers’) desire to play the game safely. After all, the risks have been quantified there in black and white, whereas the benefits of HRT are tough to quantify. It’s hard to imagine how anyone can state with any degree of certainty that “HRT resulted in a 15% decline in the incidence of night sweats” or “HRT improves skin health so that women taking the treatment look 5 years younger.”
The result of these steps was a dramatic fall in the use of hormone replacement therapy, which dropped four-fold in just 10 years, from 20% of all menopausal women to just 5%. In theoretical terms, it’s not unusual or improper for the usage of therapy to drop off when the FDA issues a serious warning like this. Thousands of medications carry some warnings but are still widely used, mainly on the basis that the alternative form of therapy doesn’t yield any of the benefits of the other drug. For example, one of the most widely used drugs in current medicine is Ozempic, prescribed to treat diabetes, and it carries its own black box warning of raised risk of several forms of cancer. Nevertheless, the benefits of Ozempic so far outweigh the risks that millions of people use it daily (and battled for years to get reliable supplies) thanks to its phenomenal benefits.
Reevaluating the Risks of Hormone Replacement Therapy
The initial Women’s Health Initiative (WHI) study primarily involved older postmenopausal women, which may have skewed the risk assessment. Subsequent analyses indicate that younger women, particularly those in early menopause, may face lower risks when undergoing hormone therapy. Additionally, the method of hormone delivery—such as transdermal patches versus oral pills—can influence risk levels.
What are the alternatives to HRT?
Spoiler alert: this is going to be a very short section. There are very few acknowledged treatments that address the causes of the problems that come from menopause. Many medications address the symptoms that women can suffer, but they have nothing to do with the root cause. One of the examples of symptom relief is antidepressants to help with sleep problems, depression, and anxiety. There’s also some peripheral evidence that they can reduce hot flashes, especially for women with clinical depression. Other off-label possibilities for hot flashes and sleep problems are Neurotonin, customarily prescribed to control seizures, and Vezoah, which is a nonhormonal medication that reduces moderate-to-severe hot flashes or night sweats.
Help for the discomforts that come from vaginal dryness can be found in creams and lubricants like AndroFeme, which is specifically designed to address those issues that come with menopause.
When it comes to alternative medication that works to actually reverse the causes of menopause, the offerings are sparse. It generally comes down to advice about lifestyle changes, such as regular exercise, wearing loose clothing, and staying cool to help with night sweats.
Welcome back, HRT
Now, thanks to the latest article in Women’s Health, I feel much more confident in spreading the word that Hormone Replacement Therapy should still be regarded as the #1 option for the prevention of the adverse effects of estrogen depletion that accompany menopause. Remember, there’s no “cure” for menopause, but HRT has been shown in many studies over many decades to be an effective way of preventing or lessening the symptoms that it can cause.
Quoting the Women’s Health article, author Dr Stephanie Faubion, medical director of the Menopause Society, wrote, “Five years after the initial Women’s Health Initiative report…a 2007 update to the study actually found that women in their 50s who took hormones had a 30 percent lower risk of dying than those who didn’t take them. This breakthrough moment came when researchers realized the old results had included women who began hormone therapy in their 60s and older—instead of focusing on women ages 45 to 55 who were just entering menopause. Those who started hormone therapy later in life were already at risk of heart problems and cancer, which skewed the results and made hormone therapy seem more dangerous than it actually was.”
As reported in the Women’s Health article, These conclusions have been reinforced by other studies, which concluded that hormone therapy is safe for women who start it before the age of 60. So now it’s out in the open. When taken correctly, HRT yields benefits that can outweigh the known risks. Of course, I am not saying that it’s suitable for everyone, nor that it should be done except under the direct supervision of a supportive and qualified healthcare provider, but, as the article I found relates, the “villain” that HRT came to be represented as is much more of a heroine, lifting us from the grip of menopause.
