What if Hormones after Menopause were Good for You After All?

I write this piece because of the unnecessary suffering I, as a gynecologist, see in my practice every day. It involves women and their doctors who are terrified to use hormones in menopause especially since the report of the Women’s Health Initiative (WHI) came out in 2002 with its dramatic negative findings.

There are, or there should be, many red faces at the National Institute of Health (NIH) these days as they are coming to realize that their initial blanket condemnation of hormone replacement therapy (HRT) after menopause failed to interpret the results of the WHI correctly.
The error was to lump together women from 50 to 79 years of age together without appreciating that in the younger women the results favored HRT.

Now as they have been able to analyze the results by age group they are saying that women within 10 years of menopause who start taking HRT have NO negative consequences particularly with breast cancer and heart disease. It is mainly those who started taking the hormones 20 years after menopause that did not benefit.

They are now saying, and hopefully this positive news will filter into the news media, that younger women at or around menopause can enjoy not only feeling good and free from menopause side effects (hot flashes, night sweats, insomnia, moodiness, irritability, anxiety, depression, mental confusion, loss of libido, and reduced sexual response), but that they can take HRT for at least 10 years with the benefits far outweighing any risks.

There is no need for women to suffer the often-debilitating effects of the menopause. There is no need to fear estrogen. Even the WHI found that women on estrogen only (those who had had hysterectomies) had less breast cancer and heart disease at the end of the seven years of the study than those women who took placebo.

This does not come as a surprise. There are hundreds of studies in the medical literature showing the benefits of estrogen on the heart and blood vessels, and as heart disease kills one out of two women it is the most important health issue for aging women.

In contrast, breast cancer kills about one in 28 women. More than 70 percent of breast cancer patients survive and indeed the largest cancer survivor group in the U.S. is breast cancer survivors.

The fear of the association of estrogen and breast cancer is greatly exaggerated. There are many studies which show a positive effect of estrogen on the breasts which is protective for breast cancer. So the finding of the WHI of less breast cancer in women on estrogen alone conforms to previous findings.

Now here is some more good news! Estrogen is available in patches and gels that allow for absorption through the skin rather than orally. This offers further health benefits, including the avoidance of venous blood clots.

Also for those women who still have their uterus and therefore need to take progesterone to balance the effect of estrogen on the uterine lining, there is now a pure progesterone product that appears to be more beneficial to the heart and breast than the older product used in the past and in the WHI study.

What about the claim of the WHI that HRT caused more dementia? We now know that this was seen only in the women over the age of 75 who started HRT for the first time at that age! There are studies that show that women who took HRT in menopause had less Alzheimer's Disease in old age than women who didn't.

How long should women take HRT? The evidence is now convincing that at least till the age of 60 benefits much outweigh risks. From 60-70 there seems little cause for concern particularly if all the usual breast exams and mammograms are carried out. Over the age of 70, a woman should consult with her gynecologist who would need to take all health and lifestyle issues into account. The sad fact is that no study has ever been done to answer this question.

The advise that women should "take as little HRT for as short a time as possible” has no study to support it and is no longer the position of the North American Menopause Society.

If you stopped your HRT or haven’t started because of unjustified fear it is time to get back to your gynecologist for a serious discussion.

To contact Dr. Melmed regarding hormone replacement therapy and menopause, please call 303-788-8808. Dr. Melmed is an Assistant Clinical Professor at the University of Colorado Health Sciences Center and a practitioner at Mountain Vista Women's Care in Englewood, CO.

Article posted January 15, 2008.

Hormone Replacement Therapy & Menopause

For most gynecologists working to help women going through menopause, the misinformation regarding hormones for treating menopausal problems is most frustrating. Hormones have received a bad reputation, which has been a detriment to women’s health.

Over the last 100 years, women’s life expectancy has nearly doubled; from 47 years to nearly 80 years. This means that women will live about 30 years or more after menopause. Women going through menopause no longer produce the hormone estrogen and without this hormone there is a steady aging and weatherization that affects the heart, mind, bones and vagina. This in turn affects quality of life. As doctors we want to give our patients not only longer lives, but healthy and enjoyable ones too; better quality of life.

There is considerable scientific evidence accumulated over more then 50 years demonstrating the benefits of estrogen to women. We now have transdermal estrogen, which is delivered in patches or cream placed on the skin that offer added safety.

Most so call “natural” herbs used to control menopause symptoms are not adequate to provide all the benefits we want and women should not fear taking estrogen because of a concern about breast cancer. Heart disease is the big killer of women; 1 in 2 die from heart disease while 1 in 28 die from breast cancer. Some studies actually show a protective affect on the breast regarding breast cancer in women taking estrogen! So, if you are in, or approaching menopause, please discuss this with your doctor. 

To contact Dr. Melmed regarding hormone replacement therapy and menopause, please call 303-788-8808.

Article posted June 15, 2007.

Vulvar and Bladder Pain Syndrome

One of the most devastating medical problems affecting otherwise healthy women, and sexually active women in particular, is a condition called vulvodynia.

This is often associated with a burning and/or itchy discomfort in the vulvar area and often excruciating pain when attempting intercourse. This condition has a devastating psychological impact and is very disruptive of relationships. The cause of vulvodynia is still unknown and as a result there are many different treatments for it.

There is a national organization formed to give information and support to women with this problem called the National Vulvodynia Association. Two or three times a year this organization publishes articles discussing various treatment options. Treatments can be medical (oral and local medication) or physical (excising the painful skin). We favor a non-surgical approach and have been successfully treating women with this condition for more than twenty years.

At times, the bladder also may be uncomfortable with symptoms suggestive of a bladder infection. This is called interstitial cystitis and there are treatments available for this difficult problem - some more effective than others.

When scheduling an appointment for either of the conditions, please indicate what you believe to be your condition, so your appointment will be long enough for the doctor to give you the attention you need.

To contact Dr. Melmed regarding vulvodynia or interstitial cystitis, please call 303-788-8808.

Article posted June 13, 2007.