Menopause Hormone Therapy (MHT)
Menopause Hormone Therapy (MHT)- attention all women age 40-60
Menopause hormone therapy (MHT) is the revised name for hormone replacement therapy (HRT). Experts have changed the name to reflect the truth- the goal of treatment is not to replace hormones that are inappropriately lacking and therefore correct the imbalance. The goal is rather to support menopausal women with hormones, for an undetermined length of time. The truth is at menopause and beyond, those hormones are never coming back. The hormones I’m talking about are estrogen and progesterone and these hormones are present from early puberty to menopause- the majority of a woman’s life. The reduction of these hormones at menopause is not a slow decline, much like testosterone in men. It is more a kin to them falling off a cliff. One day a woman has them, and then next day POOF- they’re gone.
The lack of support within our medical system for women suffering from menopausal symptoms, has gotten much media attention lately. CBC recently ran a story titled, Women are suffering needlessly through menopause transition, physicians say (link provided below). Organizations such as the North American Menopause Society (NAMS), The Society of Obstetrics and Gynecology (SOGC), and The Canadian Menopause Society are working to educate physicians and the public on current treatment options and the shortfalls in our healthcare system for women suffering. For the last few decades, women have been hearing messages like “tough it out”, “ all women suffer around this time”, “these symptoms are normal- everyone gets them”. What’s normal is most mammals die at the end of their reproductive lives. Horses, dogs, cats, elephants- they can reproduce and their fertility remains up to the end of their lifespan. In 1900 women had an average lifespan of 50yrs.. What’s the average age of a woman who enters menopause? You guessed it – 52! Women (in Canada) now on average live until the age of 83.9 yrs! 1 That’s 30 years without any cycling estrogen and progesterone. You ask, why does this matter. Let’s dive a bit deeper.
To clarify a few definitions, peri-menopause refers to women around the menopause transition. This time frame can last 5-7 years and is often marked with some mild to moderate irregularities in cycle length and changes to hormonal symptoms. It can start in the early to late 40’s and ends with the transition to menopause. Menopause is defined by the absence of the menstrual cycle for one year. You can think of menopause as the one year anniversary of the last menses. After the one year mark, a woman becomes post menopausal. The average women has post menopausal symptoms for 4-7 years.
What are the most common symptoms? Peri-menopausal symptoms are often associated with heavy bleeding (and then the iron deficiency sequelae), difficulty sleeping in the second half of the cycle, headaches before the menstrual cycle and worsening of PMS. This is often due to a decrease in progesterone due to poorer quality eggs being ovulated. As a women approaches menopause, menses begins to space out in length and the night sweats, hot flashes, and brain fog set in because periods of little to no estrogen or progesterone take hold. This is a tricky timer for healthcare practitioners to navigate, as periods of low estrogen are interrupted by cycles of high estrogen coined “estrogen storms”.
Once the ovaries are finished producing eggs, and menopause has happened, the new “ normal” of no estrogen and progesterone become reality. Hot flashes, night sweats, brain fog, difficulty sleeping, joint pain, and anxiety/ depression are felt by many. These symptoms on average last for 4-7 years 2 as the body makes this transition. Other longer lasting effects of no estrogen and progesterone are thin, dry vaginal walls, declining bone mass, increased rates of diabetes, and increased likelihood of cardiovascular disease (CVD). Cardiovascular disease is the #1 cause of death for women and causes more deaths/ year than all cancer types combined. 3 Women who are given postmenopausal estrogen have a 40% to 50% reduction in the risk of coronary artery disease in comparison with women who do not receive any hormone. 4
Menopause hormone therapy (MHT) has been studied extensively, since then 1960s. The positive effects on bone health, cardiovascular disease and diabetes prevention are undisputed. 5 The correlation with breast cancer has been the great concern. The studies with show the greatest correlation between breast cancer and MHT show an increase of 6 cases of breast cancer for every 10,000 women taking MHT. 6 Described by some as “not statistically significant”.
The practicing guidelines from the SOGC and NAMS now state, A women should no longer be advised to take MHT for the shortest time period with the smallest dose, but rather women are advised to use the appropriate dose for the time needed to manage their symptoms. Because many women will experience bothersome symptoms for many years, long-duration hormone therapy use may be needed, and an arbitrary age-based stopping rule is not clinically appropriate. 7
MHT can make a huge difference in the quality of life for women suffering from menopausal symptoms. It is important to source out healthcare providers that have specialized training in treating menopausal women. Organizations like NAMS provide searchable data bases for women trying to find physicians in their communities. Integrated Health Clinic has several doctors who are registered with NAMS and who have completed the NAMS certification program. (NCMP). You don’t need to suffer! Come start the conversation.
To keep the discussion going, please give us a call 604-888-8325.
Dr. Karen Parmar, ND
References
- World Data.info. Life Expectancy for Men and Women
- Avis Nancy E., Crawford Sybil, Greendale Gail. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015;175(4): 531-539
- Jemal A, Siegal R, Ward E, et al. Cancer Statistics, 2008. CA Cancer J Clin. 2008; 58:71-96.
- Goldman L, Tosteson AN. Uncertainty about postmenopausal estrogen.
Time for action, not debate. N Engl J Med. 1991;325:800 – 802. - Bluming Avrum, Tavris Carol. Hormone Replacement Therapy: Real Concerns and Fake Alarms. The Cancer Journal. March 20
- Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended post stopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013; 310: 1353-1368.
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society (NAMS).
Other reading suggestions:
Women are suffering needlessly through menopause transition, physicians say. https://www.cbc.ca/radio/whitecoat/women-suffering-menopause-transition-1.6727351
Estrogen Matters- by Avrum Bluming and Carol Travis
