An Informed Approach To Menopause Treatment Can Change Lives

A shift in the way physicians and patients view hormone therapy as a treatment for menopause symptoms could better the lives of women across Canada.

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Menopause is a natural part of aging, and every woman’s experience with it is unique. Unfortunately, for many, symptoms like hot flashes, night sweats, joint aches, mood swings, and sexual dysfunction can be disruptive, embarrassing, and just get in the way of daily life. There’s no reason to let these symptoms interfere with one’s quality of life. Different treatment options exist and women should feel empowered to seek them out.

“Women tend to feel like menopause symptoms are their cross to bear, as though they have a biblical or historical need to live through these very bothersome symptoms,” says Dr. Michelle Jacobson of Women’s College Hospital in Toronto. “You don’t have to suffer. There are safe, accessible, and affordable treatments to help you stay at the top of your game in this important time of your life.”

A proven treatment, needlessly abandoned

Hormone therapy has been known for half a century to provide relief from many menopausal symptoms. It helps ease the burden of menopause and lets women get on with their lives. What’s more, there’s good evidence that it’s protective against heart disease and other ailments common in post-menopausal women. It was never a one-size-fits-all solution. There are some legitimate medical reasons why hormone therapy might be contraindicated for some women. Fortunately, today women have access to a range of hormone-based therapies, non-hormonal therapies, complementary therapies, and lifestyle adjustments that can help them manage menopause symptoms with ease.

And yet, for healthy women entering menopause at the expected age, hormone therapy was long the gold standard. So, what changed?

In 2002, the Women’s Health Initiative (WHI) conducted a study designed to specifically investigate the protective cardiac effects of hormone therapy. The results were not what they expected. Overnight, headlines everywhere were declaring hormone therapy a risk factor for both heart disease and breast cancer. Of course, the real story was much more nuanced than a headline could capture.

“The real takeaway from the WHI study was that there are risks to starting hormone therapy for women who are more than 10 years past the onset of menopause,” explains Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada (SOGC). “But when you look only at the younger women in the study, not only was there a cardiac benefit, but overall mortality rates were lower than for women who were not on hormone therapy.”

In terms of public perception, though, the damage was already done. Patients and health care providers became hesitant to use hormone therapy, even in the situations where it had previously been successful. “Many women stopped using hormone therapy and many physicians stopped prescribing it,” says Dr. Jacobson. “Unfortunately, that included younger patients who were affected by menopausal vasomotor symptoms (such as hot flashes and night sweats), resulting in a generation who suffered through these symptoms unnecessarily.”

Study after study has since reaffirmed that the cloud of fear hanging over hormone therapy was unfounded all along, but minds change slowly. “For nearly 20 years, prescribers have been heavily influenced by the headlines that came out in 2002, and it’s very hard to undo a headline, ” says Dr. Blake. “As physicians, we believe in the motto of medicine, to ‘above all, do no harm,’ so the hesitancy to prescribe is somewhat understandable. But there is always a need to reassess. There is little in medicine that remains unchanged for 20 years, and we can’t base medical decisions today on research or reporting from 20 years in the past.”

The fog of misinformation is beginning to clear

Today, evidence-based information and new research are finally reaching both doctors and patients. The most recent position statement from the North American Menopause Society (NAMS) on hormone therapy clearly addresses the concerns raised by the WHI study and dispels the myths surrounding it. “There was a period where the general belief was that a patient could only take hormone therapy for a maximum of five years before the risks started to outweigh the benefits,” says Dr. Jacobson. “The newest NAMS guidelines now focus on individualizing treatment for the patient. In other words, we now give each patient the appropriate amount of hormone therapy for as long as she needs to be treated.”

It’s the beginning of a new narrative that holds the promise of righting a significant wrong. Unsubstantiated fears surrounding hormone therapy caused a generation of women to let menopausal symptoms needlessly eat away at their quality of life. But today’s generation is both better-informed and increasingly proactive when it comes to their health.

Real women living better lives

Jody Franklin, 47, is the Director of Business Development at SOGC. For some time, she had been noticing a slow deterioration in many areas of her well-being. “Because the onset of symptoms was so gradual, I assumed they were just signs of natural aging,” she says. “I was sleeping poorly, having bladder issues, noticing that my skin was less supple, experiencing mood changes, and just generally feeling like I had less energy. It was like I was living in a fog. I never really associated any of it with menopause until I started treatment and saw such a dramatic improvement.”

Jody began hormone therapy in April of this year and started feeling the positive effects almost immediately. She knew the treatment could work quickly, but was surprised to see rapid relief from issues she hadn’t even realized were related to menopause. “I hadn’t been sleeping well for the last couple of years and I was always blaming my husband’s snoring for waking me up,” she recounts. “Then I wouldn’t be able to fall back asleep because my body temperature was up and down, too hot and then too cold. When I started hormone therapy, I immediately began sleeping better and my body temperature became more stable at night.”

Through her work in the health care industry, Jody has been privy to the most recent research and recommendations. She thus felt empowered to advocate for her own health, and that’s something she wants to share. “I remember learning, from my own mother, that anything related to women’s health was taboo to talk about,” she says. “It’s a shame that so many women have missed out on a better quality of life because they didn’t seek treatment. I’m hopeful that my generation is setting a better example in that regard for the next generation of women.”

If you’re experiencing menopause symptoms, speak to your health care provider about the different treatment options available. If you’re looking for additional resources, the SOGC is dedicated to providing the public with trusted information about menopause. Please visit MenopauseandU.ca to learn more.

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