Menopause hormone therapy

What is a hormone?

Hormones are the messengers in the body. They travel through the bloodstream and can start, stop, speed up or slow down your body processes.

What are the symptoms of perimenopause?

  • menstrual cycle changes
  • sleep changes
  • headaches
  • hot flashes
  • weight gain

Why do hormones levels change during perimenopause?

  • The ovaries age during perimenopause and release fewer hormones.
  • The ovaries also become less responsive to other hormones such as  Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH).
  • FSH and LH help control the estrogen, progesterone and testosterone levels.

What happens to your hormone levels during perimenopause?

  • Progesterone levels decrease during perimenopause.
  • Estrogen levels will fluctuate but eventually,  the estrogen levels will decrease as perimenopause progresses.

This change in hormone levels will affect your body in many ways.

How do the hormone level changes affect our body during perimenopause?

effects of menopauseWhole body

  • Decreased estrogen levels may lead to hot flashes and night sweats.
  • Weight gain that occurs with middle age.

 Skin

  • Drier skin and increased wrinkles.

Brain

  • An increased risk of mood swings, memory loss, tiredness, and losing concentration.
  • Headaches -If you are prone to headaches you may experience more of them during perimenopause.
  • Stroke -there is an increased risk of stroke when you are post-menopausal

 

Heart

  • Decreased estrogen levels increase the risk of heart disease

Bones

  • Decreased bone density occurs which increases your risk of a fracture.

Urinary tract

  • Increased risk of urinary tract infections
  • An increased risk of incontinence or leaking

Vagina

  • Dryness
  • Increased risk of pain during sex

Hormone replacement Information

  • Hormone replacement therapy has been shown to relieve most of the physical menopausal symptoms.
  • Hormone therapy can help reduce the risk of osteoporosis, breast cancer, and heart disease.

Hormone replacement and weight loss

  • Weight gain will come either way with estrogen either or without
  • There is no conclusive evidence that indicates it helps you lose weight.
  • Instead of relying on hormones to help you lose weight during perimenopause and menopause consider a diet with plenty of lean protein, whole grains, vegetables and an increase in the amount of exercise you are currently performing.

Side effects of hormone replacement FDA

  • breast soreness
  • bloating and stomach cramps
  • water retention
  • headaches
  • mood swings and headaches
  • nausea
  • spotting

Why are there so many concerns about hormone replacement?

  • The Women’s Health Initiative (WHI) trial was a trial that was launched in 1991 and consisted of a set of clinical trials and an observational study.
  • There were 161,808 participants who were postmenopausal.
  • The clinical trials were designed to test the effects of postmenopausal hormone therapy, diet changes, calcium and vitamin D supplements on heart disease, the risk of fractures as well as the risk for breast and colorectal cancer.
  • The trial was stopped early in 2002. There was a concern that those women who had been on hormones had a higher risk of breast cancer, heart disease, stroke, and blood clots.
  • The WHI Memory Study showed that women over the age 65 who took hormones were twice as likely to develop dementia as those taking a placebo.

Reference  NIH

Note on the Women’s Health Initiative

  • The  Women’s Health Initiative used one medication, a combination of an estrogen (Premarin) and progestin (Provera).
  • More studies would be needed to determine if different dosages, the combination of medications or a different delivery system would change outcomes.

Risk of heart attack with hormone replacement

  • Follow-up studies found that the risk of heart attack was greatest in women who took hormones for greater than 10 years.

What are the current recommendations for hormone replacement for women who are having menopause symptoms

  • Hormone therapy is now conservatively recommended for the short-term treatment of menopausal symptoms.
  • It’s also well established that estrogen, alone or combined with a progestin, is the most reliable treatment for menopausal symptoms.

Endocrine Society

  • “Current evidence does not justify the use of menopause hormone therapy to prevent coronary heart disease, breast cancer, or dementia”
  • “Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause.”
  • “Health care professionals should individualize therapy based on clinical factors and patient preference.”
  • “Women should be screened for heart disease and cancer risk”
  • For those with higher risk low-dose, vaginal estrogen creams can be used to help with urinary problems.
  • “Vaginal moisturizers and lubricants are available for those not choosing hormonal therapy.”
  • “All postmenopausal women should embrace appropriate lifestyle measures.”

Reference Endocrine Society practice Guidelines

What is the recommended duration of menopause hormone treatment?

  • The  FDA has recommended using hormone therapy only in low doses for a short time for severe menopausal symptoms.
  • It is safe to take these hormones for up to five years at doses that relieve hot flashes. Reference Harvard Health

Chronic diseases and hormone replacement use

U.S. Preventive Services Task Force (USPSTF)  recommend against the use of both combined estrogen and progestin and unopposed estrogen (for women post hysterectomy) for the prevention of chronic conditions  such as osteoporosis and heart disease

Hormones and the black box warning

What is a black box?

  • According to the FDA, “Boxed Warning This type of warning is also commonly referred to as a “black box warning.” It appears on a prescription drug’s label and is designed to call attention to serious or life-threatening risks.”
  • After the Women’s health Initiative, the FDA required a black box on estrogen products.
  • The FDA required manufacturers to add a “black box” warning not just to Premarin and Prempro, but to all approved estrogens and progestogens which are used for hormone replacement therapy.

Below is Prempro’s black box Warning

  • “WARNING: CARDIOVASCULAR DISORDERS, BREAST CANCER, ENDOMETRIAL CANCER and PROBABLE DEMENTIA

    See full prescribing information for complete boxed warning.

    Estrogen Plus Progestin Therapy

    • Estrogen plus progestin therapy should not be used for the prevention of cardiovascular disease or dementia (5.1, 5.3)
    • The Women’s Health Initiative (WHI) estrogen plus progestin substudy reported increased risks of stroke, deep vein thrombosis (DVT), pulmonary embolism (PE), and myocardial infarction (MI) (5.1)
    • The WHI estrogen plus progestin substudy reported increased risks of invasive breast cancer (5.2)
    • The WHI Memory Study (WHIMS) estrogen plus progestin ancillary study of WHI reported an increased risk of probable dementia in postmenopausal women 65 years of age and older (5.3)

    Estrogen-Alone Therapy

    • There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens (5.2)
    • Estrogen-alone therapy should not be used for the prevention of cardiovascular disease or dementia (5.1, 5.3)
    • The WHI estrogen-alone substudy reported increased risks of stroke and DVT (5.1)
    • The WHIMS estrogen-alone ancillary study of WHI reported an increased risk of probable dementia in postmenopausal women 65 years of age and older (5.3)”

*Remember the study only included one medication at a specific dose yet the warning applies to all estrogen medications.

How common is menopause hormone therapy use?

  • The National Health and Nutrition Examination Survey (NHANES) estimated that 22% of women over 40 used hormone therapy in 1999.
  • In 2010 almost 5% of women were estimated to be using hormone replacement.

Heart disease

  • Subsequent analyses suggest that the risk of heart disease appears to depend upon the age of hormone replacement as well as the duration of treatment.
  • No additional risk was observed in those younger than 60 years of age.
  • Mortality rates appear to be lower in young women who are using hormone replacement compared to those who are not.
  • For young, symptomatic postmenopausal women, short-term menopause hormone treatment is considered to be a reasonable option

Tune in tomorrow to learn about different types of hormone treatments including bioidentical hormones.

What do you think about menopause hormone therapy?

  • Th choice is up to you and your physician.
  • I have no interest in taking hormone therapy. I dress in layers which help with hot flashes. I also sleep with layers of blankets so that I can easily remove them during the night if I am too hot.
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