• Hot flashes
• Night sweats
• Vaginal dryness
• Painful intercourse
• Confusion
• Memory issues
• Urinary incontinence
• Stiff joints
• Fatigue
• Mood swings
• Depression and anxiety
• Irritability
• Irregular periods
But some women have trouble with the extra doses of estrogen from hormone replacement therapy. A 2002 study by the Women’s Health Initiative was troubling and raised concerns in the medical community. That study indicated that an added risk of heart problems, stroke, blood pressure issues and other maladies was tied to hormone replacement therapy.
Those findings led to a cutback in the number of prescriptions doctors made for HRT. But now, that stance is being reevaluated, as new evidence suggests that hormone replacement therapy for women early in menopause has less risk than for those who are post-menopause, which comprised a large number of the 2002 study subjects.
THE BEST CANDIDATES FOR HRT
Most woman are considered fully menopausal around ages 51 to 52, marked by the cessation of periods for 12 consecutive months and presuming there are no other factors, such as surgery to remove the ovaries and/or uterus, chemotherapy or radiation treatments that bring an earlier onset.
Hormone replacement therapy seems to work well for younger women as long as they don’t stay on HRT for the long-term. The limited timing may have preventative benefits, helping to stave off osteoporosis, limiting heart attack risk, and lessening the chance of developing diabetes. A recent study estimated that HRT cut heart attack and other cardiac deaths by as much as 32 percent in women aged 60 and younger. In contrast, women older than that seemed to have an increased risk for the first year of therapy but then had reduced risk after that.
The most common hormone replacement therapy is estrogen. But a synthetic form of the estrogen-related hormone progesterone called progestin can be combined with estrogen in women who still have a uterus. The danger is that progestin will stop cell growth in the uterus, which may lead to uterine cancer.
RE-EVALUATING THE EVIDENCE
The study done by the Women’s Health Initiative beginning in 1991 examined hormone replacement therapy in women, looking at the use of estrogen plus progestin in women who still had a uterus, and use of estrogen in women who did not have a uterus. The groups were further divided into those receiving estrogen therapy and those who received a placebo.
The hormone medicated groups were found to have an increased risk of blood clots and stroke compared to the placebo group, while the estrogen plus progestin medication also had an increased risk of breast cancer and heart attack.
But now, doctors believe healthy women in their 50s are unlikely to experience much of a difference in health risks if they begin HRT at that time. Women in their 60s who start on HRT are more likely to have already developed heart disease and other issues, and any increased risk compounds those problems.
The Women’s Health Initiative study used subjects whose average age was 63. That raises serious questions on whether those studied were already advanced in the stages of heart disease, rather than put in that condition by the HRT.
In short, the 2002 study was potentially looking at the wrong group of people when evaluating the risk factors.
CANDIDATES FOR HRT
As hormone replacement therapy is being re-examined, doctors are again recommending its use. The United States Food and Drug Administration has also chimed in, recommending hormone replacement therapy for those who have severe menopause symptoms that are affecting the quality of life.
There is still some hedging on the FDA’s part. They do not recommend hormone replacement therapy as a way to prevent diseases, noting that there are better ways to achieve lower risks of heart disease and other illnesses.
Caution is recommended. There continue to be unknown issues associated with long-term hormone replacement therapy. It may be prudent to take lower doses of estrogen and other hormones, and to undergo the therapy provided it alleviates some of the major symptoms.
There are alternatives to hormone therapy, and the concerns raised about HRT have led to an increase in their use.
NATURAL PRODUCTS FOR HRT
Of course, anyone taking natural herbal supplements should consult with a doctor before starting a regimen, particularly if already taking medications for other conditions. Some products may interfere with the function of the other medicine.
There are concerns about supplements that go beyond their promises. Not every product contains the same amount of whatever it claims to contain, and marketing can play an overly large role in the presentation and promises.
As with any medication, read the label and keep to recommended doses. Supplements are not regulated by the Food and Drug Administration, meaning research is lagging or absent to support many contentions.
Some HRT replacement options include:
1. Black Cohosh – This supplement offers relief from hot flashes and other menopause symptoms. It may affect the liver and can affect women prone to breast cancer.
2. Phytoestrogens – These are naturally occurring estrogens found in food. They include isoflavones (which are found in soybeans and other legumes) and lignans (typically occurring in flaxseed, whole grains, vegetables and fruits). There are some indications that phytoestrogens could interfere with tamoxifen, used to combat breast cancer, so consult a doctor before using it.
3. Bioidentical hormones – These are bioidentical formulations that mimic natural hormones. There are some available via prescription that may be more reliable than over-the-counter supplements.
4. Dehydropiandrosterone (DHEA) – A natural steroid that comes from the adrenal gland and used occasionally to relieve menopause symptoms, but its claims are unverified.
There are also various relaxation techniques that may help. Yoga, acupuncture, and biofeedback are useful with menopause conditions and don’t carry the risks of medication. And there is always exercise -- many doctors note that getting out and moving about reduces stress and can help invigorate the body.