Dr. Jones: What's new in the treatment for menopausal symptoms? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health Care, and this is The Scope.
Announcer: Covering all aspects of Women's Health, this is the seven domains of women's health with Dr. Kirtly Jones on The Scope.
Dr. Jones: Before the 1960's there wasn't much for the treatment of menopausal symptoms. In the 1970's we found out that women who took just estrogen, had a greater risk of uterine cancer and women and physicians were hesitant to prescribe. In the 1980's and 90's we learned about all the benefits of estrogen and added progestin to protect the uterus, and lots of women took hormones for menopausal symptoms. In 2000, the results of the women's health initiative suggested that women over 60 who took hormones had a higher risk of breast cancer and heart disease. You should be asking yourself what does "higher" mean? For Scope listeners, and prescriptions dropped off.
The North American Menopause Society's older guidelines suggested that the lowest dose of hormones for the shortest period of time, should be offered. And many clinicians only offered for hormonal therapy for five years, but now we have new guidelines informed by research from the past ten years. So what is new now?
What's new isn't really new to those of us who've practiced menopausal medicine. What's new is that the decision to take hormonal therapy for menopausal symptoms or non-hormonal therapy for menopausal symptoms is a conversation that takes more than just a few minutes in your clinicians office. The clinician must be informed about the real numbers involving risks and benefits of hormone therapy and they must have the time to talk to the patient about her symptoms, her options in therapy, her benefits and her risks. And because menopause symptoms change over time, the conversation should happen every year. Most women can safely use hormones if they want and hormones shouldn't be discontinued just because of a women's age. It's an individual risk/benefit analysis.
So this is what often happens. "My period stopped and I'm having terrible hot flashes". The clinician says, "Just wait, they'll go away soon." Well, that's not necessarily true, hot flashes persist for an average of 7.4 years. Some women will feel better in several months but the majority of women with troublesome hot flashes will have them for years.
Another, "I'm only 55 and my bone density shows that I have thin bones. What should I do?" Well here's a prescription for a medicine that will block bone thinning. No, it isn't hormone." Well, drugs like bisphosphonates do decrease bone thinning but they have their own risks and benefits and for young women, meaning within ten years of menopause, estrogen might be a good choice. And estrogens are FDA approved for the prevention of bone thinning. Estrogens have the benefits of protecting bones, treating hot flashes and vaginal thinning that causes pain with intercourse.
For the two main symptoms of menopause, hot flashes and vaginal dryness, estrogen is the best therapy. The new "North American Menopause Society's Guidelines" outline the importance of individualizing therapy for each woman. Looking at the options, discussing the symptoms and the patient's own biology. There are few if any absolute contraindications to hormonal therapy. It's all risk/benefit discussion. If the risks are small and the benefits for the woman is great, than the options should be open. The first ten years after menopause, the last period, are the years when the benefits are the greatest and women who had early menopause for whatever reason might have significant benefits of taking hormones for longer.
Dr. Joanne Pinkerton, who's the executive director of the North American Menopause Society and is the lead author of the new guidelines said, in an interview, "We want to remove the fear of using menopausal hormone therapy for healthy women under 60 and within ten years of menopause and make sure the benefits and the risks are discussed with women in an appropriate way."
What should you do if you're significantly troubled by menopausal symptoms? For those of you who are just getting started, if you're babies about menopause, there is a lot of not very scientific information out there on the web. Be careful and if you need menopause basics go to menopause.org/forwomen. For those Scope listeners who are data driven, you can go the website for the North American Menopause Society which is menopause.org and look at their treatment guidelines and clinical care recommendations. They are free for non-members, and there are guidelines on menopause therapy, treatment of vaginal thinning and non-hormonal treatments for menopause that actually work and which ones don't work.
If your clinician isn't a specialist in menopause, these guidelines are available to them too. Be prepared for your visit for with your doctor. What are your symptoms? How much do they bother you? What is your medical history? And what are your fears and concerns and hopes? Clinician time can be limited, but if your questions aren't answered or you need more time, make another visit. But coming prepared will help you and your clinician focus on your needs. For the many main symptoms of menopause, there are lots of options, and there is something that will work for everyone. You can feel better, and being informed is a really great start.
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