With the introduction of hormone therapy in the 1960s, women flocked to their doctors to treat their menopause symptoms. The therapy was groundbreaking and provided relief for millions of women. The treatment grew in popularity until the early 2000s. The use of hormones abruptly dropped after a women’s health study raised serious concerns over risks. With few other options available, the fallout from the study left an entire generation of healthcare providers struggling to treat women in their menopausal years. This gaping hole in women’s health is now getting addressed with more education, research, and a look back at that sentinel study that stopped it all.
What is menopause
Natural menopause occurs when a woman or person identified as female at birth has gone 12 months without any period. This defines the end of not just menstruation but also the end of fertility, as the ovaries are no longer functioning as effectively. This decreased function results in less hormone production, primarily the estrogen hormone. An estimated 1.3 million women enter menopause each year, with approximately one-third of their lives spent in menopause. The average age for natural menopause is 51 years. But symptoms may begin up to 10 years before menopause in what is known as perimenopause or the menopause transition.
Surgical menopause involves removing both ovaries with a surgery known as an oophorectomy. The removal of ovaries relates to medical issues, which can occur at any age. The missing ovaries will trigger menopause symptoms due to the lack of hormones they typically produce.
Common Menopause Symptoms
| Hot flashes are the sudden sensation of warmth in the face, neck, or chest with or without sweating | Night sweats are hot flashes with sweating that occur at night |
| Difficulty sleeping, which may cause daytime fatigue and irritability | Thinning of bones (osteoporosis), which may cause bones to break more easily |
| The vaginal skin may become thin or dry, causing irritation and painful sex | Urinary issues such as recurring urinary tract infections (UTIs) and incontinence |
| Mood changes, such as depression or irritability | Anxiety |
| Joint pain, aches, or stiffness | Hair loss or thinning |
| Memory or concentration problems, commonly called “brain fog” | Heart palpitations where your heart beats suddenly become more noticeable |
| Decreased interest in sex | Tinnitus, a constant ringing in the ears |
| Weight gain | Increased facial hair |
Types of hormone therapy
Hormone therapy is the use of prescription medications to boost hormone levels in the body. For the treatment of menopause, this therapy replaces the declining estrogen and progesterone. For menopause, this therapy comes in two types.
Systemic therapy. Estrogen and progestin, or similar compounds, are absorbed into the blood and travel throughout the body to treat symptoms. This method is very effective at treating hot flashes. Systemic therapy comes in the form of:
- Oral pills
- Patches placed on the skin
- Gels or sprays placed on the skin
- Ring inserted into the vagina
Low-dose therapy. Also known as vaginal estrogen therapy, this medicine treats just the vaginal area in the form of topical or vaginal creams. Low doses rebuild and moisturize vaginal tissue. Because of the small doses of this therapy, there are fewer risks as only a minimal amount enters the bloodstream.
Concerns about hormones for the treatment of menopause
In 1991, the Women’s Health Initiative (WHI) began a long-term study on women’s health. The study focused on cardiovascular disease, cancer, and osteoporosis-related fractures. In 1998, the study looked at hormone therapy use with both estrogen and the combination of estrogen and progestin. By 2004, researchers had stopped both studies early after finding increased risks of heart disease, stroke, pulmonary embolism, and breast cancer. The halting of the studies made headlines, leading many women to stop using hormones. Women aged 52-65 had the greatest decline as use dropped 88% in this group.
The impact of the WHI study was profound. Few other treatments were well studied. An entire generation of healthcare providers were left lacking information on treating menopause, and women felt this. A survey in 2021 found that 73% of women ages 40-65 were not getting care for their menopause symptoms. An additional 65% said they would not consider hormone therapy.
The benefits of treating symptoms
About 70-80% of women have menopause symptoms negatively affecting their quality of life. Hot flashes are the most reported symptom and can last more than a decade. However, up to 40% of individuals will continue to have symptoms into their 60s, and up to 15% will have hot flashes into their 70s. Hot flashes affect not only physical comfort but also sleep and mood.
The tide is changing with menopause treatments. Since the WHI study, research has shown hormone therapy is safer in younger women. Starting MHT within 10 years of the onset of menopause or before age 60 poses less risk. Hormone therapy is the most effective method of treating vasomotor symptoms like hot flashes. About 80% of women get relief from symptoms within two weeks of starting hormone therapy. There are still risks, and each individual should discuss their personal risk with their healthcare provider. Risks associated with hormone therapy:
- Stroke
- Uterine cancer
- Blood blots
- Breast cancer
For many, the benefits of hormone therapy outweigh the risks.
- Reduced menopause symptoms
- Relief of vaginal discomfort and dryness
- Improved bone health
- Ease symptoms of overactive bladder
- Lower risk of cardiovascular disease
- Reduced risk of developing type 2 diabetes
But hormones aren’t the only treatments. More research backed non-hormonal options are available to treat a variety of symptoms.
When to see a healthcare provider
Menopause treatment is in the spotlight with organizations nationwide. Locally, Oregon Health and Sciences University (OHSU) began offering training on menopause care. The classes are offered statewide to primary care providers and community health partners. With this program, OHSU focuses on reaching healthcare providers located in rural areas, including Tillamook County.
The impact of menopause symptoms cannot be understated. They are disruptive for many women daily, affecting how they feel, work, and relate to others. Perimenopause and menopause symptoms last for a decade or more, yet 1 in 8 adults still avoid talking about menopause. If you have perimenopause or menopause symptoms, talk with your healthcare provider. You can discuss:
- Whether you have reached menopause
- The symptoms you have and how much they affect you
- Your health risks based on your age and general health
- Whether hormone therapy is a good option for you
- Alternative treatment options to hormone therapy
If you need assistance in finding a provider to treat your menopause symptoms, check The Menopause Society’s website for a link to menopause specialists. If you are in the Columbia Pacific CCO, look at their Find a Provider page.
Written by: Leanna Coy, FNP-BC, Freelance Health Writer
References:
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