For the millions of women going through menopause, I don’t think there is anything more confusing than the research and decisions surrounding hormone therapy. As a postmenopausal woman who uses a small dose of hormones, every new study grabs my attention. The latest headline suggests hormones are declared to be safe. Did I miss something? Has there been new research from randomized trials (the best form of research)?
It turns out that a worldwide meeting of menopause experts in Zurich, Switzerland reviewed all of the available research and concluded that for healthy women in the first 10 years after menopause – ages 50 to 59 – taking hormones is safe. There is no question that for a woman with severe hot flashes, sleep disturbance and an annoyingly dry vagina, nothing else works as well as estrogen. But the risk of breast cancer, stroke and blood clots from estrogen is hard to ignore. These risks are small in a newly postmenopausal woman but not absent altogether. So once again, women are asked to balance the benefits of hormones with the risks and make the best decision for them.
A second headline grabber this week is the news that although oral estrogen causes an increased risk of blood clots, the skin patch form referred to as transdermal estrogen apparently does not. This news comes from research looking at many observational studies of hormones and not from a randomized clinical trial. But the findings make sense. Oral estrogen must first pass through the liver to be metabolized. This first pass through the liver leads to an increase in clotting proteins. Transdermal estrogen provides estrogen in a smaller dose directly to the blood circulation and so bypasses the liver.
The final news on hormones this week – a simple cholesterol test could help determine whether hormone therapy may help women decide to take hormones or not. Researchers studying the results from the large Women’s Health Initiative Study (this was the study stopped in 2002 when the small increased heart risk was discovered in women who were on average 63 years of age when they first started hormones) found that women with unfavorable cholesterol levels were more likely to develop heart problems while taking hormones, while women with favorable cholesterol levels did not seem to have an increased heart risk. Specifically, women who had a “bad” LDL to “good” HDL cholesterol ratio less than 2.5 did not appear to have increased heart risk while taking hormones. This speaks yet again to the importance of knowing your cholesterol numbers and sizing up your personal risk of hormones together with your doctor. Click here to download a test result-at-a-glance form to help you keep track of all your test results.
So why have I decided to take hormones? Because in addition to annoying hot flashes that waken me at night, I believe from a look at all the evidence that by starting a small dose of estrogen at menopause I will protect my heart and bones and maybe even my brain, colon and eyes. On the other hand there is no question that by starting hormones 10 years or more after menopause it may be too late for estrogen to protect your heart – and a little more likely it will harm.
The latest headlines are another reminder that no “one-size-fits-all” solutions apply for all women. If you are young and considering hormones, talk to your doctor about taking: the lowest possible dose of estrogen, the skin patch form which bypasses the liver, and a natural form of progesterone rather than the synthetic progestins (if you have a uterus and need to protect it from estrogen build up of the lining every month or so for about 10 to 12 days total).
As always, I welcome your comments and questions to this very confusing matter.
Dr. Marie Savard
ABC News Medical Contributor