Menopause And Hormone Therapy: A New Understanding

Misunderstandings about hormone therapy have kept a generation of women from ideal menopause treatment, but the narrative is beginning to change.

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Dr. Jennifer Blake photographed at the SOGC office in Ottawa, ON. (Photo: Max Rosenstein)

Menopause is a natural part of every woman’s life. Some few lucky women breeze through menopause with little or no inconvenience. But for most, it’s a time of hot flashes, night sweats, disrupted sleep, and general discomfort. The good news is that safe and effective treatments exist to alleviate these symptoms, so long as we can get past the stigma and misconceptions about menopause and its treatment.

For women who experience problematic menopause symptoms, the negative effects on their quality of life can be severe and far-ranging. “The things that bring most people into the office are the hot flashes and night sweats,” says Dr. Robert Reid, a professor in the Department of Obstetrics and Gynaecology at Queen’s University. “Though these are the symptoms that bring people in, we also take the opportunity to talk to them about other symptoms that can develop as a result of menopause, particularly vaginal dryness and discomfort during intercourse. These are symptoms that women might be uncomfortable bringing up on their own, and they’re also treatable with hormone therapy.”

The gold standard

Hormone therapy is the gold standard for treating menopause symptoms. Adjusting a woman’s hormone balance with either estrogen and progesterone or estrogen alone as she transitions through menopause can not only prevent many of the more unpleasant symptoms, it can also provide beneficial protection against other conditions that become more prevalent with age. “When women are appropriately treated, they’ll notice decreased hot flashes and improvements in their sleep quality,” says Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada. “There will be a reduced risk of bone fractures and osteoporosis, as well as a significantly reduced risk of diabetes. What’s perhaps most reassuring, though, is that there looks to be about a 40 percent reduction in heart disease among women on hormone therapy.”

That reduction in heart disease is noteworthy, not only because heart disease is one of the leading causes of death in post-menopausal women, but also because the inaccurate belief persists among the public — as well as among some health care providers — that hormone therapy is dangerous, even as the science shows the opposite. The result is that many menopausal women are delayed far too long from discovering the benefits of hormone therapy. “By the time a woman works up the courage to talk to her health care provider, she has often tried lots of other things without success,” says Dr. Denise Black, a gynaecologist and assistant professor at the University of Manitoba. “And then, when they do talk to their health care provider, they often encounter a reluctance to prescribe hormone therapy, even though it’s the gold standard for treatment today.”

Building a new narrative

This reluctance can be traced back to a 2002 study on hormone therapy conducted by the Women’s Health Initiative (WHI). The study was widely reported as having demonstrated a link between hormone therapy and both breast cancer and heart disease. Further investigation, however, showed that those links were both tenuous and not representative of the population for whom hormone therapy is recommended. “To summarize in one line the problem with the WHI study, it’s that they extrapolated findings from an older population to a younger population that wasn’t adequately represented in the research trial,” says Dr. Reid. “If you put a bunch of 79-year-old women on treadmills turned up to maximum speed, some of them are going to fall off with a heart attack. But you can’t take that evidence and then conclude that exercise is bad for your health.”

Sixteen years on from that study, our understanding of treatment for menopause symptoms has grown dramatically, even if some misconceptions remain. Hormone therapy is now known to be far safer than we had previously thought or even hoped, and there are reliable methods for mitigating the risks that do exist. The benefits in terms of effective management of difficult symptoms, as well as the potential for cardiovascular-protective effects, have led the medical community to broadly recommend hormone therapy for symptomatic women under the age of 60 and within 10 years of the onset of menopause. And the rise of individualized medicine means that health care providers are taking greater care to find the specific treatment plan best suited to each woman’s needs.

For women whose quality of life is being disrupted by menopause, there are absolutely paths to better living, and hormone therapy is one of them. “The bottom line is that women do have options,” says Dr. Blake. “There’s no one-size-fits-all solution, but it’s a great opportunity to talk to your health care provider about how best to set yourself up for good health in the decades to come.”

The SOGC team photographed at their office in Ottawa, ON. As Canada’s leading authority on women’s health, the group is committed to changing the narrative around menopause and hormone therapy. (Photo: Max Rosenstein)

If you are experiencing menopause symptoms you should consider speaking with your physician. If you’re looking for additional resources, the SOGC is dedicated to providing the public with trusted information about menopause symptoms and treatment. Please visit www.menopauseandu.ca to learn more.

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