Ask the Expert: Managing Menopause Symptoms With Hormone Therapy

While all women will have menopause at some point in their lives, each will experience it differently. Symptoms can range in types and severity, including irregular periods, hot flashes, difficulty sleeping and/or vaginal dryness. Hormone therapies are the most widely used prescriptions drugs for addressing these symptoms, and the number of options can be confusing.

Dr. Missanelli, a Sharp-affiliated OBGYN, answers a few questions about hormone therapy for managing menopause and shares information about the health benefits and risks that may be associated with these treatments.

What are the different types of hormone therapies used to treat menopause symptoms?
Generally, hormone therapies can be categorized as follows:

• ET, or estrogen therapy — Treatment of menopause-related conditions with estrogen was once called estrogen replacement therapy, but the FDA mandates use of the newer term. “Replacement” is a misnomer because this therapy offers only a fraction of the estrogen that was once provided by the ovaries.
• EPT, or estrogen plus progestogen therapy — Estrogen provides most of the symptom relief while progestogen is added to protect the uterus from estrogen stimulation.
• HT, or hormone therapy — Hormone therapy technically encompasses both ET and EPT, but the FDA refers to EPT as HT.
• Custom-compounded hormones — Recently, there has been an interest in custom-mixed hormone products, which are recipes of one or more hormones that vary in amounts depending on an individual’s prescription. Bioidentical hormones fall in this category and refer to “natural hormones” — a loosely defined term that women would assume to mean safer, but is open to interpretation. Scientists and health care providers refer to bioidentical hormones as those which are chemically identical to the hormones produced, primarily in the ovaries, by women during their reproductive years.

Who should consider adding progestogen to estrogen therapy?
Women who have their uterus should consider EPT. Progestogen protects the uterus and balances the effects of estrogen. Using ET alone can more than triple the risk of developing cancer of the uterus, but adding progestogen prevents the uterine lining (endometrium) from thickening and greatly reduces cancer risk. Along with the guidance of her health care provider, each woman should consider her personal situation to determine if EPT is right for her.

In addition to managing menopause symptoms, what are the health benefits and health risks that women should consider with hormone therapy?
While hundred of clinical studies show evidence that HT relieves menopause symptoms, HT has been associated with some serious risk, such as breast cancer, in certain groups of women. There are also several large studies that have clarified the impact of HT on heart health, which may reduce risk of heart disease in certain woman while probably increasing risk in others. Furthermore, several trials have determined that HT can reduce risk of osteoporosis, particularly with use of calcium and vitamin D.

As with all therapies, the benefits, risks and side effects of hormone therapies, as well as its association with dosage and short- or long-term use, should be carefully weighed for each woman. There is no one-size-fits-all approach. A woman’s decision will be largely influenced by the severity of menopause-related symptoms, risk factors for diseases, personal health and philosophy.

Factors such as age, risks, preferences, available treatment options and cost will also impact a woman’s decision and each woman must decide if the potential benefits outweigh her potential risk.

Are there any special considerations regarding HT for women who experience early menopause (at or before age 40)?
There can be additional health risks for women who go through premature menopause, and HT will often be recommended. In fact, fewer health risks are seen in treated women than in untreated women.

How can I best decide what option is best for me when considering HT?
There is no single way to ensure the best possible quality of life when facing menopause, as each woman is different. My first recommendation is to find research and facts from a reliable and credible source such as the North American Menopause Society www.menopause.org.

Secondly, it is important for a woman to discuss her options and situation with her healthcare provider in order to weigh her own potential benefits with potential risks. Only after examining and understanding her own situation and consulting with her health care provider can a woman make the best treatment choice.

We hope you find this website helpful, but please remember that Sharp HealthCare does not control or endorse the information presented on this website, nor does this site endorse the information found on www.sharp.com.

For More Information
To learn more about Sharp's women's health services or to find a Sharp-affiliated doctor, search for a San Diego OBGYN or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm. To find general information about women's health, visit Women's Health in Adult Health or read the Women's Health News archive.