Risks of hormone therapy

Q: I am 50 years old and stopped having periods about eight months ago. I saw my family doctor and he did blood tests and said I am menopausal. I have been having a lot of the symptoms like hot flashes, night sweats, fatigue, insomnia and terrible mood swings. I worry about the bad things I hear about hormones and wonder if they are still being recommended. What are the pros and cons of taking hormones?

A: Hormones are the most effective way of relieving menopausal symptoms, but there are a lot of factors to consider when deciding whether hormone therapy (HT) is the right choice for you.

According to the 2002 Women's Health Initiative (WHI) study taking combine oral HT (estrogen and progesterone) slightly increases your risk for heart attack (7 more per 10,000 women per year), stroke (8 more per 10,000 women per year), blood clots (18 more per 10,000 women per year) and breast cancer (8 more per 10,000). The benefits include fewer cases of colorectal cancer (6 fewer per 10,000 women per year) and hip fractures (5 fewer per 10,000 women per year).

Having your health care provider review your personal and family history for additional risk factors is important prior to starting HT.

The biggest motivation for taking hormone therapy is moderate to severe vasomotor symptoms (hot flashes and night sweats) because they can be so debilitating and don't always respond well to other treatments. If you and your health care provider choose HT for you, it is recommended you use the lowest effective dose for the shortest amount of time possible.

Many of the other menopausal symptoms can be effectively relieved with medication (or lifestyle modification) with fewer risks than HT. For example a menopausal woman who is only experiencing mood changes might do well with increasing exercise, getting adequate rest, and taking supplements and/or prescription medication to treat mood disorders and avoid HT.

There are many options for the route of administration of hormone therapy (HT). Hormones come in the form of a pill, cream, gel, shot, troche or patch. Some hormones are synthetic and others are bioidentical (or bioequivalent). The risks/benefits may vary slightly according to the route of administration and manufacturing or compounding process but none are without potential risks.

There are a number of over the counter supplements (such as Black Cohosh, Wild Yam and Dong Quai) that may relieve menopausal symptoms to some degree also.

I would recommend you schedule a visit with your health care provider to discuss treatment options for managing your menopausal symptoms.

Thanks! ~Lisa