Many of us from the mid-forties onwards will experience symptoms like thinning hair, mood change, brain fog, irregular periods, night sweats, and hot flushes which we find out probably retrospectively that they are all evidence that you are transitioning to menopause.
The challenges
The challenges that come with effectively managing this life event of perimenopause is compounded because menopause is treated as a taboo topic.
Yes, in some circles it is spoken of more, but in many families and workplaces, it is not spoken about enough.
Historically Clinicians spend very little time being taught about menopause. The result of this is a woeful lack of support and knowledge from them.
According to the National library of medicine survey. The 947 perimenopause women that were surveyed found that
“Many women were massively disappointed when they would go to their GP, hopeful of feeling supported, but their GP had no idea what to prescribe for them.”
They resoundingly complained that their GP lacked awareness of perimenopause/menopause and how disappointed they were when their GP consultations would lead to an unsatisfactory end without even a mention of perimenopause or menopause.
A friend of mine has aching joints, low mood and hot flashes & is in her 50s.
She was told she was stressed and to take painkillers by her GP who did mention menopause but not any solutions to manage it.
An Effective treatment?
One of the most effective treatments (according to the international menopause society) for Perimenopause. is Menopause hormone therapy or hormone replacement therapy.
Some clinicians are reluctant to prescribe this or seem to know little about it.
Why?
History of Menopause Hormone Therapy
The 1890s treated menstrual cramps & irregular/absence of periods
1920’s Ovarian hormone extract was proven to alleviate menopause symptoms
1928 Premarin (estrogen derived from pregnant mare urine) was when it became a commercial product.
1942 Hormone therapy approved.
1980 Prescribed treatment.
2002 Publication of the women's health Initiative report
Study of Risks & benefits of HRT
In the 1990s menopause hormone therapy was used by 15 million women in the USA.
(https://www.nytimes.com/2023/02/01/magazine/menopause-hot-flashes-hormone-therapy.html
The National Institute of health in the USA commissioned the Women’s Health Initiative, to conduct a hormone trial.
It was designed to address the risks and benefits of the long-term use of hormone therapy for the prevention of chronic disease in postmenopausal women.
The study itself was designed with what would come to be seen as a major flaw.
W.H.I. researchers wanted to be able to measure health outcomes i.e how many women ended up having strokes, heart attacks or cancer — but those ailments may not show up until women are in their 70s or 80s. The study was scheduled to run for only 8½ years.
So they weighed the participants toward women who were already 60 or older. The average age was 63.
That choice meant that women in their 50s, who tended to be healthier and have more menopausal symptoms, were underrepresented in the study.
Report findings
“The results show both adverse effects and benefits from the estrogen plus progestin therapy.
Crucially, however, the adverse effects outweigh and outnumber the benefits. By outnumber, I mean that more women had adverse effects from the therapy than benefitted from it.”
This announcement given at a press conference changed the way many women felt about using hormone therapy.
Cases of breast cancer and cardiovascular disease had increased while the main benefits were fewer hip fractures and cases of colorectal cancer.
Women on the estrogen plus progestin therapy had a 26 per cent higher incidence of breast cancer than those taking a placebo.
Another perspective in analysing Data
The context is important in analysing this data.
A woman’s risk of having breast cancer between the ages of 50 and 60 is around 2.33 per cent. Increasing that risk by 26 per cent would mean elevating it to 2.94 per cent. (Smoking, by contrast, increases cancer risk by 2,600 per cent.)
Another way to think about it is that for every 10,000 women who take hormones, an additional eight will develop breast cancer. Avrum Bluming, a co-author of the 2018 book “Estrogen Matters,”
This gives another perspective on the findings.
Hormone replacement therapy today
There are 50 types of hormone therapy treatments that are licensed around the world. They all have different formulations.
Estrogen only is the safest, but only suitable for those who have had a hysterectomy. If not you also have to take progesterone as this combination will reduce the occurrence of endometrial cancer.
The more modern applications e.g., transdermal, sprays etc are safer than formulations used in the trial that took place over 20 years ago.
If you want HRT to be one of the tools you use to manage your HRT, discuss why he recommends a particular formula and sticks to appointments for monitoring/follow-up. Bear in mind though that getting a formula that works for you will be initially a matter of trial and error.
Examples of Hormone therapy
The confusion, and controversy of this trial plus the lack of availability of hormone therapy, has led to
opening a burgeoning market for untested and unregulated alternative treatments, including custom-compounded hormone products that are not regulated which have raised concerns about dose consistency,
product contamination, and unsubstantiated safety and efficacy claims.
Bioidentical hormones
These are hormones that are similar to yours. They are natural and made from yam plants. It is similar to the estrogen in your ovaries (British Menopause society)
Compounded Hormones
They are manufactured in pharmacy and are adjusted to the needs of the patient, however, they do not follow regulatory policy and do not have the same amount of scrutiny as HRT
Conclusion
Hesitancy to prescribe/ use HRT was heavily influenced by the controversial WHI report which had a flawed method.
They could not discern the efficacy of using /HRT for 50-year women when the average age of women tested in the trial was 63.
There are new formulations since the trial and other methods including patches and sprays that are safer to use/
It does have benefits for osteoporosis and like all treatments can have increased risks for cardiovascular disease but this also depends on the formulation.
If you want to explore this option to mange your perimenopause symptoms, Seek help from your GP.
If they are uninformed about menopause encourage them to visit or update their training with the British Menopause Society. https://thebms.org.uk/
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