“Twenty-five percent of women going through menopause will seek attention for their symptoms,” says Sinai gynecologist Carolyn Harraway, M.D. For the last 60 odd years, help has come from hormone replacement therapy (HRT) administered in a pill containing estrogen—or estrogen combined with progestin.
Now, a multiyear, federally funded study called the Women’s Health Initiative, reports that combination (estrogen + progestin) HRT may increase the risk for heart disease. Also, combination HRT has shown a small, but statistically significant increase in the risk for breast cancer, stroke and blood clots.
So what’s a gal to do? Gynecologists say education is the key. HRT is effective in reducing most of the symptoms of menopause. It can also alleviate vaginal dryness and improve the appearance of skin and hair because it reduces collagen loss. And, until the study was released, physicians believed that hormones had a preventive effect against heart disease.
“It’s a risk-benefit analysis,” says Karen Engstrom, M.D., an obstetrician/gynecologist at Sinai. “If you don’t have the symptoms of menopause and have been taking hormones because you thought it would prevent heart disease, then it’s not worth the risk. If, on the other hand, your symptoms are severely impacting your life, then it might be worth the risk.”
“You should also stop or not take hormone replacement therapy if you have any conditions that would make it inadvisable,” adds Harraway.
“A person with a history of liver disease, of stroke or blood clots, with heart disease or with undiagnosed vaginal bleeding should not have hormone therapy,” Harraway cautions.
Fortunately, there are plenty of alternatives to traditional HRT, all of which should be discussed with your physician.
For example, there are natural estrogens like those found in plants. Engstrom says these phytohormones may have fewer side effects or may be more easily tolerated by patients than synthetic hormones. But, she adds, since natural hormones are supposed to have the same effect as manufactured hormones, they may also carry the same risks for heart disease or stroke.
Among the popular alternatives to HRT is an herb called Black Cohosh, explains Ellen Taylor, M.D., a Northwest Hospital gynecologist. “It may lessen the intensity of hot flashes and has some of the same properties as estrogen, but it’s not FDA tested.” The herb may also take four to six weeks to take effect, she adds, and the results may be attributed to the placebo effect.
Soy protein with naturally occurring isoflavone has also been touted as being effective against the unpleasant symptoms of menopause. Soy protein is available in various food products including soymilk or tofu and also as a pill. “Soy seems to have an estrogenic effect,” reports Engstrom. Trying a food product probably wouldn’t be harmful, she says, but, once again, the pill forms of soy protein are not federally regulated.
Harraway says women should not ignore the truly “natural” ways of treating the symptoms of menopause. “Exercise and an improved diet will help decrease hot flashes and alleviate depression,” she says. “Even behavioral changes like dressing in layers so that you can keep yourself cool is the first line of treatment for these symptoms.”
Some women currently on hormone replacement therapy with great success won’t want to quit, says Engstrom. “Everyone should be aware of the risks, but for some women with severe symptoms, the risks are worth it.”
Though physicians won’t be turning to HRT as much in the future, estrogen therapy has not disappeared as a result of the study. “The thinking now is that hormones can be prescribed in the lowest effective doses for a finite period of time,” adds Taylor.
Menopause need not be a struggle. Taylor suggests approaching “the change” from a different perspective.
“This is a time in a woman’s life when she can become even more conscious about taking charge of her health,” Taylor says. “Menopause is a permanent change in your life, but it may not be as bad as you imagine. Most women now are informed and they are willing to wait to see what they can tolerate before trying medication.”
For more information or to be referred to a physician who can discuss HRT and its alternatives with you, call 410-601- WELL (9355).
Related Links:
Northwest Department of Gynecology
Sinai Division of Obstetrics and Gynecology
Women's Services at Sinai
What the Study Says
The Women’s Health Initiative study found that women over the age of 50 who used combination HRT had a lower incidence of hip fractures and of colon cancer than those who took a placebo. However, there was a small, but statistically significant, increase in the risk for heart attack, breast cancer, stroke and blood clots. The risk was higher than what was allowable for a clinical trial so the study had to be stopped. Out of 10,000 women, 37 had heart attacks, 38 developed breast cancer, 29 had strokes and 16 developed blood clots in the lungs.
Menopause: Words to Know |
Black Cohosh: |
Black cohosh (known as both Actaea racemosa and Cimicifuga racemosa), a perennial plant and member of the buttercup family native to North America. Some studies suggest that Black Cohosh may help relieve menopausal symptoms such as hot flashes and night sweats. |
Estrogen: |
sex hormone responsible for female characteristics. Present in women and men. |
Hot Flash/Hot Flush: |
a symptom of menopause experienced as an intense feeling of warmth accompanied by a pink flush of the head, neck and upper body. |
Hormone: |
a naturally occurring substance in the body that causes a physical effect upon specific body parts. |
Hormone Replacement Therapy (HRT): |
general term for a course of treatment with natural or synthetic forms of estrogen. |
Isoflavone: |
a type of phytoestrogen (plant estrogen) found in legumes that has weak estrogenic activity. Soy has the most concentrated amounts of isoflavone. |
Libido: |
sex drive. |
Menopause: |
complete end of menstrual cycle. The time leading up to this event is perimenopause (or pre-menopause); the time following this event is postmenopause. |
Progestin: |
synthetic form of progesterone usually taken with estrogen by women with a uterus. |
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