Hormone therapy: goodbye old narratives

I will always share my story (started menopause hormone therapy at 48; turning 58 in 2025), but be reminded that it is not my job to tell anyone to take menopause hormone therapy; it is my job to convince everyone to have an investigative conversation about the potential benefits of menopause hormone therapy for them.

Rachel asks:

I am 39, a nurse, and have an IUD. My last period was in December. Can you explain the history of why so are afraid of hormone therapy? I'm looking for a brief summary ...

My reply:

For decades, hormone therapy was the first-line recommendation for women reaching menopause--especially as a strategy for reducing things like vasomotor symptoms and reducing the risk of other future conditions, such as osteoporosis. 

In 1991, the Women's Health Initiative (WHI) Study was launched with the intention of demonstrating the potential impact of hormone therapy on heart disease prevention (heart disease continues to be the #1 premature killer of women today.) In other words, “Do estrogen and progesterone have cardiovascular benefits?”

It was a large, complex, $1 billion (estimated) US study with several primary and secondary trials. When we talk about the WHI today, we mostly talk about the hormone therapy intervention studies.

Initially, the study's recruitment goals were lofty. This has been simplified but: imagine trying to recruit 100,000+ women around the age of 50; give half hormone therapy and other half placebo and ask to follow their health for 30+ years! Instead, recruiters settled for smaller, older subsets (the majority of participants across all subsets were aged 60-79!)

A few years into the study, researchers began to notice higher incidents of breast cancer, heart disease and stroke amongst participants and the WHI study was prematurely halted in 2002.

But guess what? Rates of breast cancer, heart disease and stroke are already higher among a population that is age 60-79! In fact, the #2 risk of breast cancer (after having breasts) is age (followed by genetics and other modifiable risk factors including alcohol, weight and movement/exercise.)

Was the study flawed? In some ways, but not in all ways. Knowledge from the WHI study did provide many key learnings. More at Menopause.org.

Was the public relations & communications surrounding the WHI findings flawed and a debacle that continues to plague women's health 20+ years later? ABSOLUTELY. Initial front-page headlines reported that hormone therapy caused cancer and the damage was done. Women flushed their hormone therapy down the toilet. Physicians stopped prescribing. 

However, the tide has turned back. 

Today, menopause hormone therapy is regarded as an effective, individualized protocol, where, for the majority of women, the benefits outweigh any risks (prescribers perform individualized benefits vs risk assessments before starting ANY therapy; not just hormone therapy).  It continues to be a well-researched protocol, regarded as a first-line treatment and recommended, for optimal benefits, women start hormone therapy within 10 years of menopause (12 months period-free) or under the age of 60. This is a guideline and not a deadline. TAP BELOW for more: 

• The most current position statement on Hormone Therapy from the (North American) Menopause Society, and endorsed by menopause societies worldwide is here.

• A great read is Estrogen Matters by Dr. Avrum Bluming and Carol Tavris, PhD

• This video by Dr. Robert Reid demonstrated for me, that as a society and as adult learners, many of us were never taught how to interpret risk

• In this article, I invite Menopause Chicks to ask ourselves “Is what I'm thinking true?” (Does hormone therapy cause breast cancer?)

• In 2023, the Canadian Medical Association "reminded" all of its members that menopause hormone therapy is both effective and safe for the majority of women
  

Thanks for reading this far. I'm not sure what your definition of “brief" looked like, but I do hope this synopsis helps 🙂 In closing, I will share 3 things:

1. I started progesterone therapy at age 48 and added estradiol after I reached menopause at age 49. I turn 58 in 2025. I review at least once-per-year with my prescriber and I do not have any intentions of stopping hormone therapy unless I had an adverse health experience that called for it (i.e. a stoke.) I will always share my story. You have to get informed and make the health decisions right for you.

2. It is not my job to convince or tell anyone to take hormone therapy.

3. It is my job to convince everyone to have an investigative conversation with their health team about the potential benefits (heart, brain, bone and genitourinary health) of hormone therapy (short and long-term) for them.

Now, here is YOUR call-to-action:

• Please watch the Menopause Chicks Masterclass (which includes all the frequently-asked-questions about hormone therapy, as well as approved non-hormone therapy options) and

• Join me for the next "Ask Anything" event on January 6, 2025 at 4 pm PT/7 pm ET (you will automatically receive an e-vite when you watch the masterclass!)