Hormone Therapy
You’ll spend a third of your life postmenopausal, why not make the most of it?
Just how much can hormone therapy (HT) improve the quality of life after menopause? A lot. With women reaching menopause between the ages of 40 and 55, many think their body simply makes a transition, but that isn’t true. “Menopause is any time the ovaries no longer produce estrogen,” affirms Lauren Streicher, MD, Gynecologic Specialists of Northwestern. “With life expectancy increasing, women live well into their 80s, spending a third of their life in menopause,” says Dr. Streicher.
When doctors prescribe HT, estrogen alone is prescribed to women who’ve had a hysterectomy; those with a uterus take estrogen and progestin. “The purpose of progestin is to protect the lining of the uterus and prevent uterine cancer,” says Dr. Streicher, who also notes that HT helps relieve disruptive symptoms.
While some women don’t encounter any pain or discomfort during menopause, many do. “Most are familiar with hot flashes, but they don’t know that absence of estrogen effects the body in many other ways, often causing vaginal dryness, insomnia and mood swings, which are very distracting,” explains Dr. Streicher.
Women turn to systemic HT to alleviate these symptoms. “It’s the only FDA-approved treatment for healthy women with symptomatic menopause,” adds Kristi Tough DeSapri, MD, Gynecologic Specialists of Northwestern. “Systemic HT is prescribed in the form of a pill, patch, cream, gel or spray.” The pill, gel, spray or lotion is used daily, while the patch is re-applied once or twice a week.
Low-dose vaginal preparations of estrogen improve vulvar vaginal atrophy – vaginal dryness – and come in three forms: pill, ring and cream. “While vaginal estrogen helps alleviate painful sex caused by vaginal dryness, it also benefits women who aren’t sexually active and still experience general discomfort, irritation, odor or frequent bladder infections,” shares Dr. Streicher. As for dosage, Dr. Tough DeSapri says, “A vaginal estrogen pill or cream is usually prescribed two to three times per week, depending on the extent of vaginal dryness. The vaginal ring is prescribed every three months.”
Another benefit of HT is osteoporosis prevention. “One to two women over age 50 will sustain a fracture in their lifetime,” explains Dr. Tough DeSapri. “In our center, we focus on maintaining bone health and preventing debilitating fractures by treating with calcium, vitamin D, medications and lifestyle modifications to slow bone loss, which is a natural part of menopause and aging. Standard doses of HT can reduce fractures by up to 40 percent in menopausal women.”
What about risks? “The number one risk physicians are concerned about is blood clots, which may lead to a stroke or heart attack,” informs Dr. Streicher, who observes this risk is greater when taking oral HT as opposed to transdermal (gel, cream, spray or patch) HT. “Women who are either overweight or have a history of blood clots are more at risk. To reduce the risk of blood clots, I recommend these women lose weight and use transdermals.”
Breast cancer is another concern, but Dr. Streicher says majority of women who’ve had breast cancer never took estrogen in their life. “Current studies don’t show an increase in breast cancer for women who take estrogen alone. For women who take both estrogen and progestin, there’s a slight increase in breast cancer, particularly if they’ve taken them for more than five years. But, the risk of breast cancer from using a small amount of estrogen is not nearly as large as the risk associated with family history or obesity.” Dr. Tough DeSapri agrees: “The risk of side effects such as heart attack, stroke, blood clots or breast cancer in 50- to 60-year-olds taking HT is very low.”
In the end, the long-term benefits of HT outweigh the risks. “It’s good for cognitive function, as well as cardiovascular, bone and sexual health,” notes Dr. Streicher. “We shouldn’t take our quality of life for granted. If men stopped making testosterone at age 50 and couldn’t have sex, sleep or think, they’d look for relief from these symptoms, too.”