The Facts about MHT
Perimenopausal and postmenopausal women have a variety of alternatives for protecting their health and treating menopausal symptoms. The most common and studied of these is hormone therapy. Both women and their providers have more reservations about beginning hormone therapy, and in truth, MHT isn't for everyone. Your personal risk profile may make you a poor candidate for hormone therapy. Or you may be a person who chooses “natural” or “alternative” ways to maintain your health and alleviate menopausal symptoms. Whatever choices you make should be based on fact — not on unnecessary fears or unfounded beliefs about the safety or positive impact of this treatment option.
Who Uses MHT?
Menopause hormone therapy is used by fewer than half of all menopausal women in the United States. The reasons for using — or not using — MHT vary from individual to individual, but many women who aren't on MHT are still deciding whether it is a good option for them. Whatever technique you use to minimize postmenopausal bone loss, heart disease, muscle and other tissue degradation, memory function loss, and other effects of diminished hormones, it's best to decide before the hormone levels get extremely low. Here's what we know about the women who choose MHT and why they choose it:
Most surveys indicate that the main reason women between the ages of fifty and fifty-five choose to begin MHT is for the relief of hot flashes and other vasomotor symptoms. Women who begin MHT at age sixty-five and older are more likely to be concerned with preventing or postponing the onset of osteoporosis.
About 35 percent of perimenopausal women turn to MHT for the relief of night sweats and vaginal dryness — in addition to hot flashes.
A 1997 survey reported in the Journal of Women's Health discovered that nearly 50 percent of those who were currently using MHT had undergone a hysterectomy. In that study, over 35 percent of current MHT users and over 40 percent of past users turned to MHT as a result of surgically induced menopause. Understandably, women who no longer have a uterus have little concern over irregular vaginal bleeding.
The Benefits of MHT
MHT offers women a number of sound, solid health benefits — both in the relief of symptoms and in the prevention of some serious health threats that result from the body's loss of hormones.
MHT has proven its benefit in maintaining bone health and preventing osteoporosis. Most studies show that women who use estrogen and progestin MHT compounds reduce their risk of hip fracture by 11 percent for each year of MHT treatments. Here are just some of the other benefits of hormone replacement therapy:
MHT is the most time-proven method for reducing hot flashes, vaginal dryness, and other uncomfortable menopausal symptoms.
Estrogen may be effective in protecting the eyes from macular degeneration — the leading cause of blindness in those age sixty-five and older. Macular degeneration is the most common cause of failures for the eye examination required in the driver's license recertification process. A lack of the ability to drive a car is one of the most common causes of loss of independence and feelings of isolation and depression among the elderly.
Estrogen reduces the risk of contracting colorectal cancer by as much as a third in most studies.
Macular degeneration often takes the form of a clouding of the eye's lens. Age-related macular degeneration (AMD) causes the retina to deteriorate, and it's usually noticeable first as a clouding of the central area of vision (the peripheral vision can remain intact). AMD is the leading cause of night blindness in the United States. Many doctors recommend MHT to prevent or delay AMD.
Your personal risk profile and family history can help you and your health care provider assess the benefits of MHT for you.
The Risks of MHT
It is obvious that hormone therapy can be advantageous for many women during and after the menopausal years, but it is just as obvious that the risks need to be weighed against those possible benefits. New studies are always refining our understanding of these risks.
When the WHI study results were announced in 2002, millions of women stopped taking MHT. This created a unique opportunity to see the resulting effect on breast cancer rates. In 2006, the rates were reported to have dropped 7 percent in the year 2003 — one year after women stopped taking hormones. Although this doesn't prove a link between MHT and breast cancer, it strongly suggests it. The type of cancers most affected were the estrogen-sensitive cancers, further suggesting this link. Although the overall risk of breast cancer is still small, most health care professionals advise women who have a personal history of breast cancer against using MHT for at least the first five years following their diagnoses. Regardless of their use of MHT or family history, all menopausal women should get regular mammograms, conduct monthly self-breast exams, and visit their physician annually.
If you still have your uterus, you shouldn't take unopposed estrogen (estrogen without progesterone) for the sole purpose of relief of menopausal symptoms, because unopposed estrogen can increase your risk of developing endometrial cancer. MHT programs that balance estrogen with progestin decrease this risk, however, and may in fact help reduce the risk of endometrial cancer even further compared to women who take no hormone supplements. If you have been treated successfully for early (stages I through III) endometrial cancer, with a total hysterectomy, your doctor may recommend an ET regimen for you after a certain disease-free interval, usually three to five years.
If you have ever developed blood clots in the deep veins of your legs or in your lungs or eyes, you may be susceptible to redeveloping them if you use MHT. High levels of estrogen can contribute to this condition, so your health care professional will want to test your current blood hormone levels and review your history to see if you are a good candidate for MHT. Your doctor can order special blood tests that check for clotting difficulties if your family or personal medical history raises any question about an inherited susceptibility.
Irregular bleeding or spotting is the most common side effect complaint of women on MHT, while others report breast tenderness and water retention. And, while some women say MHT contributes to migraines, others say it actually helps ameliorate migraine problems they've experienced for years.
If you have active liver disease or if your liver's functions have become seriously impaired through illness or injury, you aren't a good candidate for MHT. If your liver isn't functioning properly, your body won't be able to metabolize the estrogen component of MHT.