Dr. Christy explains the pros and cons of using Menopausal Hormone Therapy with updated data and easy to understand charts.
Hi and welcome to another edition of your health with dr christy my name is dr christy reisinger and today i’m going to start a series on menopause today i’m going to discuss menopausal hormone therapy or mht let’s first begin by discussing the different hormones that decline as women age there are estrogens progestins and testosterone estrogen can be in various
Forms such as estradiol estrone and estral progestins can be in various forms such as micronized progesterone synthetic progestin and medroxyprogesterone lastly there’s testosterone testosterone levels actually peak in a woman in her 20s and then slowly declined with age in the 1960s many physicians and patients alike were led to believe that giving hormones during
The menopausal period would keep women feminine forever and help them retain youth and by 2001 42 of women ages 50 to 74 were taking some form of menopausal hormone therapy in 1991 a huge study called the women’s health initiative was started that involved over one hundred and sixty thousand women the study aimed to see if some of the claims about hormones were
True there were three groups studied women taking estrogen and progestin women taking estrogen alone because they no longer had their uterus due to a hysterectomy and the last group was women taking a placebo but this study came to a screeching halt in 2002 when results from the estrogen progesterone arm of the study revealed harms to women taking hormones such
As an increase in breast cancer stroke and blood clots and the study was stopped early the results were shocking i still remember learning about them during my medical training after those results were obtained the amount of menopausal women who were placed on hormones dropped precipitously but what have we learned since 2002 first let’s discuss what mht works best
For there’s absolutely no doubt that mht is the most effective treatment for hot flashes and night sweats mht has been shown to reduce the frequency of hot flashes by 75 percent and it really doesn’t matter if you take the estrogen orally or through a patch or cream but hormones are no longer used to prevent things like heart attacks cancers or dementia there just
Isn’t data to support using it that way for a very specific group of women using estrogen to prevent osteoporosis is a possibility but otherwise hormone replacement therapy at or around menopause should only be given to prevent and treat hot flashes and night sweats something important to note is that if a woman no longer has her uterus because she’s undergone a
Hysterectomy she only needs to take a form of estrogen however if a woman still has her uterus it’s extremely important that she take a combination of estrogen and progestin the initial results from the women’s health initiative showed worse side effects on those women that were taking the combination estrogen progestin than those that were just taking estrogen
Alone but as data has continued to come in and further studies have been done researchers have realized there may be a key connection between these harmful side effects and the time in which the hormones are started so the earlier you start the hormones to the beginning of menopause the lesser the harmful side effects seem to be with mht so it’s recommended
Now that if you’re going to use menopausal hormonal therapy you really should start it between the ages of 50 to 59 or within 10 years of menopause to treat symptoms of hot flashes and night sweats also we need to realize that the type of hormones that were given during the women’s health initiative may have different effects than the newer forms of estrogen
And progestin that are given now the women’s health initiative used an estrogen called conjugated equine estrogen and a progestin called medroxyprogesterone acetate so let’s go through some of the concerning and beneficial side effects of mht i think the biggest concern for women is the possible increased risk for breast cancer when using hormones ongoing data
Analysis from the women’s health initiative specifically when looking at data for women aged 50 to 59 has estimated that women that took the estrogen progestin combo had three additional cases of breast cancer per 1000 women when used for five years we can assume this risk would be lower if the hormones were used for a shorter amount of time and for women that
Only took estrogen because they didn’t have a uterus their risk for breast cancer was possibly slightly lower if they took it for five years but there was an excellent article in the lancet that was published in 2019 regarding breast cancer and mht they looked at lots of observational studies and analyzed the data and found that using mht for five years starting
At 50 years old will increase breast cancer by about 1 in 50 users for those taking daily estrogen and progestin and they found that it was still increased in women taking estrogen only but to about 1 in 200 women and they wrote if mht was taken longer than 5 years the risk for breast cancers would increase but if the mh2 was taken less than five years the risk
For breast cancer would decrease so it seems to be very dependent on the amount of time that the hormones are taken so in conclusion with regards to breast cancer the shorter the amount of time the hormones are taken the better and women taking estrogen only have less breast cancer risk than women taking the estrogen and progestin combination but just when you
Are really confused even more recent data has shown that women taking a newer type of estrogen and progestin may not have the same breast cancer risks well what about the risk for heart attacks and blood clots if a woman has a high risk of heart disease then she probably should not take hormones or should at least consider using the transdermal form when estrogen is
Taken orally it’s processed by the liver and when this occurs the level of sex binding hormone increases which can lower testosterone levels and lower sex drive it can also increase triglycerides and an inflammatory marker called c-reactive protein which is thought to possibly increase the risk of stroke and blood clots observational studies have found that getting
Estrogen delivered through a patch or gel can possibly reduce these risks and it’s the best option for women that are obese and already at increased risk for blood clots it’s also better for women who have a low sex drive and those with high triglycerides for women that also need to take progestin micronized progesterone has been found in observational studies to
Have the least side effects associated with them so the pendulum is swung to the understanding that for women younger than 60 years old or who are within 10 years of menopause onset and have no contraindications the benefits may outweigh the negatives for hormones specifically for the treatment of hot flashes and night sweats especially when used for less than
Five years so what are the contraindications well if you’re older than 60 or greater than 10 years from menopause i would caution you about taking hormones for your menopausal symptoms if you’ve had a stroke a heart attack a history of blood clots or if you have a high risk of breast cancer because it runs in your family or if you have had a personal history of
Breast cancer i would say these are absolute contraindications to hormone replacement therapy and i would discuss non-hormonal treatments for hot flashes and night sweats in this specific topic i’ll discuss further in another episode but once it’s determined that you’re a good candidate what kind and what form of hormones should you take let’s start with what you
Need if you don’t have a uterus you only need estrogen if you have a uterus then you will need a combination of estrogen and progestin usually known as progesterone because if you do not have the addition of progestin you have an increased risk for uterine cancer if you’re obese have diabetes elevated triglycerides or a low sex drive then transdermal estrogen is
The best choice for you and that means that it’s given through a patch a gel or a spray in limited studies the form of progestin that seems to be the safest is micronized progesterone for most women when menopausal hot flashes and night sweats become very bothersome and they meet the criteria they will be prescribed oral low-dose estrogen in the form of estradiol
Usually 0.5 or 1 milligram per day or through an estradiol patch that delivers a daily dose of about 0.05 milligrams if they have a uterus this will be combined with oral progestin in the form of micronized progesterone after three to five years from starting the hormones discussions should be started about slowly tapering or coming off the hormones so what about
Bioidentical hormones and what about women that are still fearful of hormones or who have contraindication to hormones are there non-hormonal alternatives and what about bladder issues vaginal dryness and painful sex that can be seen with menopause these are great questions i’ll discuss these topics in my upcoming videos thanks for joining me
Transcribed from video
Menopause Series – Part I – Hormone Replacement Therapy By Christy Risinger MD
