Menopause brings a multitude of disruptive symptoms, including hot flashes, night sweats, and sleep disturbances. Hormone therapy has been recognized as a potential treatment to alleviate these symptoms. However, many women are hesitant about pursuing this option due to longstanding concerns and ambiguity surrounding its safety and efficacy.
Hormone therapy was once a routine treatment, but its use diminished significantly following a 2002 study that was halted early due to fears regarding increased risks of breast cancer and blood clots. Although subsequent research indicated that the benefits of modern hormone therapies may outweigh the associated risks for many women, confusion and apprehension persist. Grayson Leverenz, a 50-year-old from Durham, North Carolina, expressed that despite her initial hesitations, she is now thankful for her decision to embark on hormone therapy.
Recently, there has been a resurgence of interest in hormone therapy, prompting discussions among experts regarding how to communicate its advantages and disadvantages effectively. An FDA-convened expert panel highlighted the benefits of hormone therapy and suggested that health warnings be revised or removed for certain treatments. This proposal has received pushback from many experts who advocate for careful reconsideration before implementing any changes.
Hormone therapy works by addressing the symptoms that emerge as estrogen and progesterone levels plummet during menopause. There are two main types of hormone therapy: low-dose vaginal estrogen therapy and systemic hormone therapy. Low-dose vaginal estrogen therapy is applied directly into the vagina, minimizing its presence in the bloodstream and reducing associated risks, making it suitable for women primarily experiencing vaginal dryness. In contrast, systemic hormone therapy—which includes pills, patches, sprays, gels, or vaginal rings—delivers hormones into the bloodstream at levels sufficient to alleviate symptoms like hot flashes.
Jennifer Zwink, a nurse from Castle Rock, Colorado, reported significant relief from her symptoms after using an estrogen patch combined with an IUD that provides progesterone. She observed improvement in her hot flashes, sleep quality, and even joint pain, stating that while it isn't an absolute solution, it has made an important positive difference in her life.
The Menopause Society has acknowledged that hormone therapy can lower the risk of cardiovascular disease if initiated within ten years of menopause onset. Furthermore, it may help mitigate the risk of Type 2 diabetes and maintain bone density over time, delaying potential drops in bone density.
While the potential benefits are appealing, hormone therapy also carries certain risks. After initially being apprehensive, Leverenz ultimately decided to pursue hormone therapy when her quality of life became untenable. With a combination of three medications, she experienced alleviation of anxiety, improved sleep, and reduction in joint pain and hot flashes, stating, “I just feel like myself again.”
Experts caution that many patients hesitate to use hormones due to the perceived risks, but reassure them that women can generally use estrogen therapy for up to seven years and estrogen-progestogen therapy for three to five years before the risk of breast cancer increases significantly. Both types of therapy can elevate the risk of stroke, which diminishes after discontinuation, and the likelihood of blood clots is elevated when hormones are taken orally, although it may be lower with non-oral methods such as patches or gels.
The medical community remains divided over the presence of "black box" warnings on hormone treatments. Current boxed warnings indicate higher risks of stroke, blood clots, and cognitive issues. However, many doctors attending the FDA panel, many of whom prescribe these hormones, believe the warnings should be reassessed or removed. An open letter signed by 76 healthcare professionals calls for careful scientific evaluation before any changes are contemplated. Meanwhile, medical professionals continue to advise vigilance against the misinformation proliferating on social media regarding hormone therapy's effectiveness in preventing dementia and promoting overall health in older age.
For those seeking alternatives to hormone therapy, Dr. Nanette Santoro highlighted a new non-hormonal medication, fezolinetant (marketed as Veozah), that addresses hot flashes and night sweats. Other non-hormonal options include the anticonvulsant gabapentin in low dosages, as well as moisturizers for enhancing vaginal comfort. Experts also recommend incorporating regular exercise and a balanced diet to manage menopausal symptoms, while being wary of misleading supplements purporting to be cure-alls.
