Once a woman has entered menopause, the ovaries stop making estrogen. Besides suffering hot flushes, night sweats, mood swings, and sleep disturbances, women can begin to lose protection from heart attack, colon cancer, and osteoporosis. A lack of estrogen has a huge impact on a woman's health.
Hormone replacement therapy (HRT) has been viewed with some worry for years, and those worries were supposedly confirmed with the Women's Health Initiative (WHI) Study. The first findings, published in 2004, scared 25% of women into stopping their HRT. Sadly, the study was only designed to see if hormones could be given to women later in life to obtain the same great results seen when given shortly after menopause. The public didn't understand that the average age of the women in the study was 62.3, that the increases in heart attack (8/10,000 per year), stroke (7/10,000 in the FIRST year only), and breast cancer (8/10,000 per year) were not only NOT STATISTICALLY SIGNIFICANT, but they also didn't apply to the normal woman who is newly menopausal! Interestingly, in the 10 years since the study was published, it is estimated that almost 40,000 women died from preventable causes BECAUSE they stopped their HRT!!
For women who have had a hysterectomy, only estrogen is needed to treat menopausal symptoms (progesterone, associated with breast cancer, is for protecting the uterus). Estrogen's only risk is a 2/10,000 increased risk of a clot in the leg. The benefits not only include stopping menopausal symptoms, but lowering the risk of heart attack 30-50%, the chance of colon cancer 20-32%, preventing osteoporosis, and possibly lowering the chance of stroke and Alzheimer's Disease! Estrogen does NOT increase the risk of breast cancer.
The good news for the rest of the women entering menopause with their uterus is a new drug, Duavee. This drug combines Premarin, an estrogen, with a SERM, bazedoxifene. This SERM protects the uterus from getting endometrial cancer like progesterone, but WITHOUT the slight risk of breast cancer posed by progesterones! Duavee would seem to provide the same health benefits as described above, and research is ongoing to see if Duavee may decrease the risk of breast cancer!
The discussion of menopause, and hormones, in our office, is a long one. There are a lot of definitions and facts to cover, and alternatives to discuss. We also see patients that say that HRT didn't work for them, or that desire 'bio-identical' hormones (a topic for another time!). Be assured that we can address your hormone needs and control your symptoms, even if it takes some time. Please call our office and schedule your consultation today!
Braden Richmond, MD, FACOG