Around the time of menopause, the amount of the hormones estrogen and progestin in a woman's body begins to diminish. These hormones are important components in maintaining a woman's reproductive health when she's young. And the change in these hormone levels during menopause can have important long-term health consequences.
For many years, doctors have prescribed hormone replacement therapy to help alleviate symptoms of menopause and to protect against bone loss.
However, evidence from the Woman's Health Initiative suggested that there was an increased risk of breast cancer and cardiovascular disease with combination hormone replacement therapy (estrogen with progestin).
WHI was a long-term national health study, sponsored by the National Institutes of Health, that focused on strategies for preventing heart disease, breast and colorectal cancer and fracture in postmenopausal women.
According to the National Institute on Aging, there's been some controversy around the study's findings related to heart disease, since the average age of the women participating in the study was 63. Since that's more than 10 years past the average age of menopause, some experts question how applicable these findings are to younger women.
So is HRT safe?
In fact, some research has suggested that if hormone replacement therapy is begun early in menopause, it might be protective against heart disease.
"Further study is needed," says Barbara Soltes, MD, a reproductive endocrinologist at Rush. "In the meantime, we work closely with our patients to talk about what their individual risk factors may be and we adjust our strategy accordingly.
"Thanks to our increasing understanding of hormone replacement therapy and following FDA guidelines, women are given much lower doses than they were in the past," Soltes adds. "We do everything we can to lower the risk of complications by using the lowest dose for the shortest period of time."
There are some women, however, who should consider alternatives to hormone replacement therapy, such as women who:
- Have problems with vaginal bleeding
- Have had certain kinds of cancers
- Have had a stroke or heart attack in the past year
- Have had blood clots
- Have liver disease
What are the alternatives?
Fortunately, there are a number of options for those looking for alternatives to hormone replacement therapy.
"For instance, there are a group of medications used for other medical conditions, such as antidepressant and hypertensive medications, that have proven to be effective for some symptoms," Soltes says. "Acupuncture has also been shown to be effective for some women, as have some supplements and over-the-counter medications."
If you choose to take supplements or other over-the-counter products, make sure that you let your doctor know. Some supplements may cause interactions with other medications.
"We will work closely with the patient to find which alternatives work best for her. And we are always on top of the latest research," Soltes says. "We are also doing more research here at Rush to study which non-hormonal treatments are safest and most effective."
Eating right and getting at least 30 minutes of daily moderately intense physically active is good advice anytime, but it is especially important during menopause and perimenopause (the time just before and just after menopause).
Early treatment for the heart and bones
The effects of menopause that can have the most long-term consequences are bone loss, which can lead to osteoporosis, and changes in blood lipids (especially an increases in "bad" cholesterol), which can lead to heart disease.
"This is why it's so important to see your doctor as you approach the time of menopause, whether you're having symptoms or not," says Soltes. "Whether, you choose hormone replacement therapy or alternatives, we need to make sure that we start treatment as soon as we can to protect your body from bone loss and from the factors leading to heart disease."
Heart disease is the number one killer for women over 50. "People tend to forget this, but that's why it's so important to keep a good eye on the heart and blood vessels, especially during the acute phases of menopause and beyond," says Soltes.
"Lifestyle changes are another important part of the plan," says Soltes. Eating right and getting at least 30 minutes of daily moderately intense physically active is good advice anytime, but it is especially important during menopause and perimenopause (the time just before and just after menopause).
"Physical activity can be especially helpful with managing some of the symptoms of menopause," she says.
"Just as, if not more important, physical activity is also good for the heart, and weight-bearing activity can slow bone loss," says Soltes. "I think it can play a big part in having a successful journey through menopause."
Whatever type of therapy you choose, remember that your doctor should be your partner throughout this transition period of your life. If you do choose hormone replacement, your doctor will work closely with you to determine the lowest dose to treat the symptoms for the shortest amount of time.