Early Hormone Therapy Has Benefits
27 May 2023
It was surprising news in the Canadian Medical Association Journal. There’s another about-turn among scientists studying hormone therapy (HT) as a treatment for symptoms of menopause. This time, researchers have produced findings that suggest benefits to healthy women who start HT early in the transition to menopause.
Women have long been perplexed by conflicting advice on hormone replacement, and this new study doesn’t offer universal guidance. The bottom line remains, HT is a complicated business, requiring patients and doctors to weigh many factors in deciding for or against.
Dr. Iliana Lega of the Women’s College Hospital and the University of Toronto has this to say, “Menopausal hormone therapy is the first line treatment of symptoms in the absence of contraindications.” That clarity may be overly simplified, and she adds that patients and doctors need to consider symptoms before and during menopause and to discuss treatments based on personal preferences and potential risk factors.
Those risk factors have been well publicized. Many studies have suggested leaning away from HT due to associated increased risk of breast cancer, stroke, and cardiovascular disease. But new findings offer important insights for younger women.
Previous studies have shown an increased risk of breast cancer in women taking HT. However, this new study reports the risk is much lower in people aged 50-59 years and in those who start HRT in the first 10 years of menopause.
Increased risk of ischemic stroke (blood clot) has been a concern for women older than 60 years who start HT 10 years after the start of menopause. But new findings suggest the risk is reduced for those younger than sixty.
Furthermore, data from the Women’s Health Initiative trial show a possible reduction in coronary artery disease with HT among younger menopausal patients, specifically those who start HT before 60 years of age or within 10 years of the start of menopause.
Be sure to discuss the issues with your surgeon if you are scheduled for a hysterectomy. Leaving ovaries in place can preserve natural estrogen function for a time. But removal of ovaries and use of HT eliminates any future risk of ovarian cancer. Of course, most saved ovaries do not develop a malignancy. So, sparing one or both ovaries in younger patients should be a matter for discussion.
There are other benefits of hormone therapy in the treatment of menopausal symptoms. Reducing the severity of hot flashes is the main one. Another is reduced fragility, with one large study involving over 25,000 women aged 50-79 showing that HT reduced the risk of any fracture by 28 percent, a major osteoporotic fracture by 40 percent, and a hip fracture by 34 percent. HT can also offer relief from mood swings, vaginal dryness, and joint pain.
The cognitive effects of HT are debated. Past research questioned the impact on risk for dementia. Other research found benefits including reduced “brain fog” and reduced risk of Alzheimer’s.
Dr. Pauline Maki is a specialist in menopause and cognition in the department of Psychiatry and Psychology at the University of Illinois at Chicago. She notes, “Women who initiate hormone therapy before their final menstrual period show increased blood flow to the hippocampus and better verbal memory compared to nonusers.”
The message is that “timing is everything” in decisions around hormone therapy.
That’s not easy to action given menopause may begin up to 10 years before the last menstrual period and can last more than 10 years. For some women, the symptoms are intense. Others never know the menopause has come and gone.
So get informed guidance from your doctor and start the discussion early.
