Hormone therapy has become a staple of my practice for better or worse. Women want BHRT because they want their lives back. It is hard to know what is best for each patient because genetics, lifestyle and numerous other factors play into the benefit/risk discussion for each woman. Research says that using hormones close to the onset of menopause is beneficial for heart protection. However, the same research says you should not use hormones longer than approximately 7-10 years as it can increase the risk of cardiovascular disease. On top of that, bone health is only protected for the time that you are using the hormones.
Thus I am excited about the British Menopause Society (BMS) and Women's Health Concern's updating guidelines on hormone replacement therapy (HRT). They are working towards clarifying hormone use, benefits, and risks. "Our aim is to provide helpful and pragmatic guidelines for health professionals involved in prescribing HRT and for women considering or currently using HRT," said lead author Nick Panay, BMS chair, in a news release. "With these updated recommendations, it is hoped that HRT will once again be used appropriately and provide benefits for many women in their menopause."
There are different perspectives out there of the benefits and risks when it comes to hormones. Susanne Summers has written many books about the topic. However, findings from the Women's Health Initiative in 2002 and the Million Women study of 2003 gave a more controversial picture of hormones, and women were immediately taken off this treatment.
The updated recommendations provide advice regarding optimizing the menopause transition and beyond. These include using lifestyle and dietary interventions, complementary therapies, and HRT. I feel this is where we, as naturopathic doctors, excel as diet and lifestyle changes are part of our treatment for all women.
• After receiving sufficient information from her health professional to make a fully informed choice, each woman should decide whether to use HRT.
• The clinician should individualize the HRT dosage, regimen, and duration and reassess risks and benefits annually.
• One of the main indications for HRT in postmenopausal women is relief of vasomotor symptoms [i.e. hot flashes, night sweats], which are most effectively relieved by estrogen.
• If menopausal symptoms persist, the benefits of HRT usually outweigh the risks. Therefore, the duration of HRT usage should not be subject to arbitrary limits.
• When prescribed to women younger than 60 years, HRT has a favorable benefit/risk profile.
• Women with premature ovarian insufficiency must be encouraged to use HRT, at least until the average age of the menopause.
• If women older than 60 years opt for HRT, they should start with lower doses, preferably via the transdermal route.
• Routine management of all women in the menopause transition and beyond should include optimization of diet and lifestyle.
• Pharmacological alternatives to HRT may include selective serotonin reuptake inhibitors such as fluoxetine and paroxetine for vasomotor symptoms, venlafaxine, gabapentin, and possibly clonidine.
• Phytoestrogens offer some benefits for symptom relief and on the skeletal and cardiovascular systems.
"It is imperative that in our [aging] population research [that] development of increasingly sophisticated hormonal preparations should continue to maximize benefits and minimize side effects and risks," the guidelines authors conclude.
To read more check out the full text from the Menopause Int. Published online May 24, 2013. Full text