Actress Suzanne Somers sympathizes with women suffering from what she calls "The Seven Dwarfs of Menopause: Itchy, Bitchy, Sleepy, Sweaty, Bloated, Forgetful and All Dried Up." As she's done in her best-selling books, Ms. Somers, age 62, credited a custom-made blend of "bio-chemical" hormones with maintaining her youthful zest and says that the hormone debate boils down to a choice between "restoration versus deterioration."
Millions of women abandoned menopause hormones after the big Women's Health Initiative (WHI) trial was halted early in 2002 amid signs that they increased the risk of heart attack and stroke. A growing number of experts now believe that the women in the WHI--average age 63--do not reflect the typical women entering menopause, and that the same risks may not apply to younger women.
Amid all the confusion, here are some things women should know about the hormone-replacement therapy (HRT) debate now:
'Bio-identical' hormones are available in FDA-approved forms; hormones with the same molecular structure as those that women's bodies make. The main one lost at menopause is estradiol, which affects functions throughout the female body, from skin to bones, hearts and brains. Chemically equivalent estradiol is available in many FDA-approved pills, patches, creams and gels from traditional drug companies, generally made from the exact same plant sources that compounding pharmacies use. What's more, the FDA-approved varieties are covered by insurance, unlike compounded blends that can cost hundreds of dollars a month.
There's a critical window of time for starting HRT. There's a growing consensus that the risks and benefits are different for younger and older women, and that for women who start HRT shortly after menopause, the benefits may outweigh the risks. One theory is that estrogen helps keep healthy blood vessels supple, but make atheroscierosis worse once it has set in.
The increased risk of breast cancer appears related to progesterone rather than estrogen. Women taking both estrogen and progesterone in the WHI had eight more cases of breast cancer per 10,000 than the control group; women taking estrogen alone had six fewer cases. Women who still have a uterus need some progesterone to guard against uterine cancer, but many doctors now try to give the lowest dose possible to prevent a build-up of uterine lining.
Estrogen applied to the skin, in patch, cream or gel form, may have a lower risk of blood clots and strokes than in pill form. A large study in France published in the Lancet found that women taking estrogen in pill form were three times as likely to develop blood clots than non users, while women using the estradiol patch had no increased risk. But more study is needed to determine this conclusively.
Women entering menopause should discuss all the risks and benefits with their doctors, as well as their symptoms, health and family history, and make an individual, informed decision.
Source: Health Journal: The Wall Street Journal, February 3, 2009
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