On this week's episode of HealthConnection Dr. Carole Myers, a professor emeritus in the University of Tennessee College of Nursing, speaks with Dr. Amy Alspaugh, a professor at the University of Tennessee, College of Nursing, a certified nurse midwife, and a PhD prepared nurse researcher.
WUOT’s Carole Myers: In 2002, the National Institute of Health abruptly halted the women’s health initiative study on the benefit of women’s hormone replacement therapy because of the increased risk for the women involved in the study. In the ensuing time, hormone replacement therapy has declined by 80%. Earlier this year, based on ongoing follow up studies, it was announced that the benefits of hormone replacement therapy for the treatment of menopause symptoms outweigh the risks. Why the switch from 2002 to now?
Amy Alspaugh: We really have learned, looking back at the data, that the study population wasn’t designed well for what we use hormone replacement therapy for right now. So, the study was really looking at the impact of hormones on chronic health conditions. It wasn’t looking at treating things like hot flashes or night sweats, but because they were looking at these chronic health conditions they wanted to make sure that the population in their sample was older, so more likely to experience these conditions anyway. So, it meant that the average age of somebody starting hormone therapy in this study was 63. So, we can’t take the conclusions from this study to the bulk of people that would use hormone replacement therapy today.
We misunderstood what the findings meant to the appropriate population. What are the key messages, Dr. Alspaugh, for women based on more recent study findings because I understand that they’ve continued to look at the issue of hormone replacement therapy?
So, what they found in the ensuing time since that data, and really what we already knew before the women’s health initiative, was that women that are younger than 60 years of age or within 10 years of menopause, so that’s the sensation of menses for 12 months, can actually have a very favorable risk and benefit ratio in terms of taking hormone replacement therapy. There are some individuals where it is not a great idea, so somebody who is over 60 or if it’s been greater than 10 years since they hit menopause on their own. Of course, there are other risk factors that individuals may have, such as a history of breast cancer or heart disease or stroke, that might make them not want to take hormones to begin with. For the vast majority of people, hormone replacement therapy is an effective way to treat vasomotor symptoms of menopause, hot flashes, night sweats, and can actually prevent bone loss that is associated with menopause.
What treatment recommendations do you have for post menopausal women?
I think there are so many ways to approach it. 85% of women will experience one or more menopausal symptoms, or perimenopausal symptoms, so night flashes, vagina dryness, pain with sex, mood disorders. So, it’s very common that people experience it so of course the range and the range of its severity varies. So somebody that has an occasional hot flash might not need anything. For somebody for whom it is bothersome and it impacts their ability to live a full and healthy life, treatment options are available. So, if they still have a uterus, they would take estrogen plus progestin. If they for whatever reason had their uterus removed, they can do estrogen only. These come in a lot of different forms, there’s patches, there’s pills, there’s systemic therapy which is something you would take and it would go through your whole body, there’s also locally administered medication so vaginal estrogen or you can get progesterone in a patch and that’s a lot easier for some people to take and it decreases the risk for some people. If you have hormonal menopausal or perimenopausal symptoms that are bothersome, you should absolutely reach out to your healthcare provider.
This transcript has been lightly edited for content.
