Changing the conversation around hormone therapy - Macleans.ca
 

Changing the conversation around hormone therapy

A generation of women missed out on effective menopause treatment. The next generation need not.


 
(Credit: iStock)

(Credit: iStock)

Hormone therapy is the gold standard in treatment for menopausal women, but the experts are still fighting against misconceptions and outdated fears, particularly related to a 2002 study by the Women’s Health Initiative (WHI). This year, the North American Menopause Society (NAMS) has crafted a new position statement with the goal of clearing the air and plainly communicating what today’s best science has to say about this treatment.

“The WHI study release caused a lot of fear for both women and providers regarding the safety of hormone therapy,” says Dr. JoAnn Pinkerton, Executive Director of NAMS. “Over the next ten years or so, the position in the medical community became that hormone therapy should be prescribed only in the lowest dose and for the shortest amount of time. When we wrote the 2017 North American Menopause Society position statement, we wanted to change that conversation to recommending the appropriate dose, duration, regimen, and route of administration to provide the maximum benefit with the minimum risk. Our new position statement affirms the safety of hormone therapy. It affirms the effectiveness. And it affirms that it is safe for many women to take for longer than just a few years.”

While researchers have learned that hormone therapy is not without risks in certain women, they have also discovered ways to accurately determine who is at risk and who is not, allowing very individualized treatment plans. And the women most in need of the treatment, those who are symptomatic and close to menopause, are in the lowest risk category, where the protective benefits outweigh the risks. “Age matters,” says Dr. Pinkerton. “It matters how old you are when you start hormone therapy, and it matters how far away from menopause you are as well. For women who are under 60, or within ten years of menopause, hormone therapy has many benefits. Beyond just hot flashes, it influences sleep, mood, and bone loss. It leads to fewer cases of diabetes and even less heart disease.”

There are few medications that physicians have available to them, for any condition, that provide as many clear benefits as hormone therapy does for menopause symptoms. Realizing these benefits however requires that both women and providers have an open mind and be prepared to look at the whole picture painted by the last fifteen years of science. “When you really look at the data regarding hormone therapy, you come away with a very different picture than what was in the media back in 2002,” says Dr. Pinkerton. “Hormone therapy is safer than you think. And we have options to minimize the risks that we didn’t have fifteen years ago. We have lower dose options, we have transdermal options, we have micronized progesterone.”

As long as the conversation remains stuck in the early 2000s, women will continue to miss their chance for relief, causing avoidable distress and suffering for millions of Canadian women. A generation of women missed out on effective treatment because of misinformation, but the next generation need not, so long as we can clear away these outdated ideas surrounding hormone therapy and menopause. “We think there’s a window of opportunity that many women in the last fifteen years have missed because of fear on the side of both the providers and the public,” says Dr. Pinkerton. “If we can take away the fear, then we can have a conversation where we go over the potential benefits, the potential risks, and the idea of individualized therapy. It’s going to take time to change these conversations, so we had better start now.”