Column: Hometown Health, by Fadi Yahya

Menopause is the time in a woman’s life when the ovaries stop producing enough hormones. This usually happens between 45 and 55 years of age. A woman is postmenopausal when she has not had menstrual bleeding for at least 12 months. The decrease in the hormone estrogen production may cause symptoms such as hot flashes and dryness in the genital area.

Postmenopausal hormone therapy is the term used to describe the two hormones, estrogen and progestin, that are given to relieve bothersome symptoms of menopause. Estrogen is the hormone that relieves the symptoms. Women with a uterus must also take progestin hormone to prevent cancer of the uterus. Women who do not have a uterus are usually treated with estrogen alone.

What are the latest updates in menopausal hormone replacement therapy?

The North American Menopause Society is a leading medical society that studies issues related to menopausal. Earlier this year the NAMS has convened and released new guidance for hormone treatment in women. The following is a summary of their medical recommendations in regards to menopausal hormone therapy:

• It is the most effective treatment of hot flashes.

• It can be used for prevention of osteoporosis related fracture.

• It is recommended for women with early menopause.

• Hormones are not recommended for use in breast cancer survivors.

• Estrogen treatment may decrease risk of heart disease.

• In general there are lower risks and more benefits in women younger than 60 and when started early after menopause.

• The treatment appears to have less risks when taken through the skin (e.g., patches) as compared to taking pills.

• The decision to start and when to stop treatment should be made taking into consideration the women’s health, the goals of the treatment and quality of life.

What are the newest options for the treatment of menopausal symptoms?

The FDA recently approved three new medications for the treatment of menopausal symptoms:

• Duavee: Is effective for the treatment of hot flushes and genital symptoms. Its main advantage over conventional hormone treatment is that it prevents menstrual bleeding and breast discomfort.

• Brisdelle: Is the first FDA approved non-hormonal treatment for menopausal hot flashes. The advantages of this medicine over other non-hormonal treatments, is that it doesn’t cause sexual side effects or weight gain.

• Osphena: This medicine is effective for the treatment of postmenopausal women who have problems with sexual intimacy.

Are the “natural” or “bioidentical” products safe and effective?

The bioidentical approach uses an individualized dose of hormones that is made by a pharmacy as pills, creams or vaginal suppositories. A blood or saliva sample is taken to measure a woman’s hormone levels, which is then used by the pharmacy to make the product.

Those products are not regulated and so the quality and dose of hormones can vary from batch to batch. There is no scientific evidence that those products are safer or better. Due to inadequate quality control over these products, most expert medical societies recommend that women not adopt this approach.

The issue of menopause hormone replacement therapy has witnessed a lot of changes over the last 10 years. This treatment should be individualized to each woman after a thorough discussion of all the available options with their risks and benefits.

 

Fadi Yahya, M.D., is a women’s health care specialist. He practices on the Albert Lea campus of Mayo Clinic Health System of Albert Lea and Austin. To schedule an appointment, please call 507-379-2131 or go to mayoclinichealthsystem.org.