Heading into the holidays, mothers and grandmothers across America ponder recipes between meetings and deadlines, paying bills, and polishing silver. At the same time, many of these women, despite the brave and welcoming front, fight depression and anxiety, and are self-conscious about having packed on a few more pounds since last year. Trying to handle holiday angst on top of regular life, especially with interrupted sleep, has them more emotionally charged than they were, say, five years ago. At the root of much of this oftentimes unspoken stress is the change most women dread: menopause.
A recent NPR report highlighted the ongoing blowback of a shocking and incomplete study that put the kibosh on what was thought to be the fountain of youth that would effortlessly take women through menopause.
The Women’s Health Initiative, published in 2002, found that taking estrogen plus progestin actually increased a woman’s risk of breast cancer and heart disease. Almost overnight, about half of American women taking hormones stopped, cold turkey. According to the NPR report, in women ages 50 and over, today only about 10 percent of women are on hormone therapy.
Paul Cox, an Atlanta physician specializing in anti-aging medicine and bio identical hormone replacement, says the report did an incredible disservice, as it focused only on two medications.
“I’m glad to see that people are now looking at the data instead of just reacting to this 14-year-old study that only applied to Premarin and Prempro, and does not at all apply to the proven benefits of bio identical hormone replacements,” said Cox.
“When women hit menopause, their ovaries cease to function and they lose their primary source of estrogen, progesterone, and testosterone. It is a catastrophic failure of three hormones at one time. Little wonder there are so many physiological effects,” Cox said.
“The key is to understand that all hormone replacements are not created equally. The drugs studied in the Women’s Health Initiative – Premarin and Prempro – were made from horse-derived estrogen plus a progestin. Progestin was invented for birth control, which came with warnings for an increased risk of cancer and heart disease,” Cox continued.
“More recent studies show that when estrogen is used in combination with bio-identical progesterone – not progestin – there is no increase in breast cancer or heart disease, “ Dr. Cox added.
Dr. Wulf Utian, Director of the North American Menopause Society, would agree with Cox that reaction to the 2002 study was a huge overreaction. According to Dr. Utian, another significant finding from the more detailed analysis also showed that the age at which a woman started hormone therapy had an impact on reducing the risk of heart disease.
One of the lead investigators of the study, Dr. JoAnn Manson, a professor of medicine at the Harvard T.H. Chan School of Public Health, said findings show starting therapy between the ages of 50 and 59 delivers a protective benefit.
“Women who take hormones earlier after the onset of menopause may experience less plaque, blood vessel blockage and atherosclerosis, and possibly even a reduced risk of heart attack. But for women over the age of 60, the benefit seems to disappear. This is probably because older women already have plaque buildup,” Manson says.
Starting hormone therapy earlier has a greater benefit still, according to a study done in Denmark. Women who started hormone therapy between the ages of 45 and 58 “significantly reduced their risk of mortality, heart failure and heart attack,” according to this study of 1,000 healthy women.
Cox agrees wholeheartedly, saying there are clear benefits for women who begin hormone therapy earlier, especially if they can begin within five years of menopause. Saying many of the benefits “go far beyond controlling hot flashes,” Cox adds that starting bio identical hormone therapy early also helps reduce the risk of bone fractures, diabetes, and “brain fog.”
“It’s a great idea to do a baseline check of women in their mid-thirties or earlier, and to check against that periodically so we can be prepared to help prevent or ease those symptoms of hormone deficiency: weight gain, anxiety, sleeplessness, memory issues, hot flashes, and night sweats.
“Many women treated with estrogen and progesterone in perimenopause will clear up a host of issues. And while it is not an FDA approved treatment in the U.S., the standard of care in Europe and Australia is to replace the physiologic levels of testosterone, too. Testosterone is calming. It helps with brain function and libido. It is also important for lean muscle mass and bone health,” Dr. Cox added.
“One of my patients told me, after she started treatment, that she now tells her friends to forget their nail appointments and hair appointments. The most important appointment to make is to get their hormones right,” said Cox.
Perhaps one of the healthiest gifts a woman can give herself this holiday season is a check of her hormones, and a fresh look at hormone therapy.
Hormones May Help Younger Women With Menopause Symptoms
Paul E. Cox, MD, MS
North American Menopause Society
Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial