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Hot flashes, insomnia, vaginal discomfort and more – hello, menopause!

If you’re experiencing any of those symptoms, your doctor may have recommended some form of menopausal hormone therapy. But is it safe? When should you start? And which therapy is right for you?

Researchers have been trying to answer those questions for decades, often with confusing and even conflicting results. Let’s take a look at the history of estrogen therapy, and how past studies are informing the latest recommendations.

A French physician coined the word ‘menopause’, and advanced the revolutionary idea that the health concerns of aging women deserved medical attention, in the 1800s. Throughout that century, doctors experimented – sometimes on themselves – with various animal hormones. The science was far from perfected; but by the 1890s, women were being treated successfully for symptoms of menopause with a powder or pill made from cow ovaries.

In the U.S., doctors experimented with bio-identical estrogen replacement and developed a synthetic estrogen replacement in the 1930s. Usage surged over the next several decades, especially after a popular book suggested menopausal hormone replacement could keep women ‘feminine forever’.

The research surged at the same pace; but science couldn’t keep up with seemingly conflicting information, and the market followed its ups and downs. Estrogen was the fifth most prescribed drug in the country by the mid-70s after one study suggested it helped bone growth; but prescriptions plummeted and it earned an FDA warning after it was linked to a rise in endometrial cancer. Conflicting studies on other cancers and cardiovascular health followed, along with FDA investigations. Meanwhile, doctors formed their own opinions and passed them on to women who experienced a wide range of side effects and symptom relief.

Today, hormone therapy remains controversial, leaving many women hesitant to try it, yet suffering in silence from a variety of menopausal symptoms. But as the experts review fifty years of studies, here’s what they know for sure.

Truth takes time. Many of the earlier studies have been criticized for poor selection of participants and controls; and repeated studies over five decades offer a much better understanding of what hormone therapy can and can’t do. Researchers now say it is still the most effective treatment for hot flashes, genito-urinary discomfort, and preventing bone loss. However, because research still proves inconclusive regarding cardiovascular and cancer risks vs. benefits, it’s best used when symptoms impair quality of life, and at the lowest effective dosage.

When (and how long) you take it matters. Menopausal hormone therapy is safest for women under 60 who begin it less than 10 years from the onset of menopause. The risk of cardiovascular issues, stroke, and dementia rise after that. Timing and duration appear to be related to breast cancer risks as well. For these reasons, estrogen therapy is recommended for short-term use.

Forget one size fits all therapy. Pills or patches? Estrogen alone or combined with progesterone? How much and how long? Your symptoms and your risks should determine whether hormone therapy is right for you, and what your treatment plan should be. And follow up is critical during this season of change.

When prescribed carefully and used correctly, menopausal hormone therapy can be an effective way to ease symptoms and boost your sex life; but it doesn’t have to be the only way. Pelvic floory physical therapy works on the secondary effects of menopause - the pain you experience due to a drop in hormones. If hormones were the exclusive reason you are having painful intercourse, then adding hormones would be the cure. But for many women, this is not the case. The musculoskeletal system becomes involved, and a Women's Health pelvic floor physical therapist is not only your advocate, but may also be your solution.  Whether or not hormone therapy works for you, a menopausal consultation with a women’s health physical therapist might be just what the doctor ordered as well!

 

Citation

Kohn G., Rodriguez K., Hotaling J., and Pastuszak A. 2019. The History Of Estrogen Therapy. Sexual Medicine Reviews 7:3  416-29.

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