Ask the Dr. – Hormone Therapy

285 Q&AHormoneHormone Therapy Q&

with Marjory L. S. Gass, MD, NCMP

Which symptoms of menopause are most likely to be alleviated by hormone therapy?

The most common menopausal symptoms are hot flashes (and the nighttime equivalent—night sweats) and vaginal dryness, the latter of which can lead to painful intercourse. Some women may also experience moodiness and difficulty concentrating during the menopause transition. Typically, hot flashes, moodiness, and difficulty concentrating are temporary symptoms; however, medical science cannot predict how long hot flashes will last for each woman.


How is hormone therapy administered?

Estrogen products for hot flashes are available as oral tablets, injections, and as transdermal patches, gels, emulsions, and sprays that are applied to the skin. For women with a uterus, the hormone progesterone must be added as protection against uterine cancer.

Very low doses of estrogen to treat vaginal dryness are available as tablets, creams, and rings for use in the vagina.

Many factors influence a woman’s decision to use a particular hormone product, particularly her preferences regarding treatment options and the cost of the product. She should discuss the pros and the cons of hormone therapy with her clinician, being sure to review the issues of her age and her personal risk of blood clots, stroke, breast cancer, and heart disease.


What are bioidentical hormones?

The term bioidentical hormones usually refers to formulations compounded for an individual woman. The term implies that these hormones are identical to those made by the ovaries and are therefore safer and more effective than the many government-approved commercial products. But compounded hormones are neither all natural nor all safe, and they have not been tested in trials or approved by the US Food and Drug Administration (FDA)—nor are they regulated or tested on a consistent basis. The FDA has stated that the risks of all hormones are similar. Patients receiving compounded hormones should receive a package insert that describes the risks as well as the benefits.


Is hormone therapy safe for all women?

No, hormone therapy is not safe for all women. Women at high risk for blood clots, stroke, heart attack, or breast cancer could be at even higher risk with hormone therapy. In the 10 years since the Women’s Health Initiative trials published the side effects of hormone therapy, much has been learned about the benefits and the risks. We now know that hormone therapy is safer when used by healthy women close to menopause—the older the woman, the more side effects were found. Doses and length of therapy have been decreased for many women, which should add to the safety of hormone therapy.

Additional research is needed to understand the effects of estrogen alone versus estrogen plus progesterone, and the role of aging versus menopause, genetics, and lifestyle on midlife women’s health.


What questions should a woman ask her physician about hormone therapy?

If a woman wants to take hormone therapy, she should ask her provider if she is a good candidate. She should discuss which type of hormone therapy is best suited to her, how long she might take it, and what the chances are of symptoms recurring when she discontinues it. She should ask about the natural course of menopausal symptoms and other measures she can take to reduce symptoms. A healthy lifestyle is key to improving chances for a healthy future.  _


Margery L. S. Gass, MD, NCMP, is an internationally recognized leader in the field of menopause. Dr. Gass became executive director of the North American Menopause Society (NAMS) in 2010, having been a member since 1993. She is a consultant at the Cleveland Clinic Center for Specialized Women’s Health and a clinical professor at Case Western Reserve School of Medicine in Cleveland, Ohio. Dr. Gass came to NAMS from the University of Cincinnati College of Medicine, where she was a professor of clinical obstetrics and gynecology. She was also director of the University Hospital Menopause and Osteoporosis Center in Cincinnati. Dr. Gass has served as a principal investigator for the Women’s Health Initiative and has published and presented on a wide range of topics related to menopause, including osteoporosis, sexual dysfunction, and hormone therapy. She has authored numerous articles and book chapters on menopause-related topics and has co-edited a book on managing perimenopause. Dr. Gass has served on the Advisory Committee of the National Center for Complementary and Alternative Medicine and on the Advisory Committee of the Office of Research in Women’s Health, part of the Office of the Director of the National Institutes of Health. She is editor of Menopause: The Journal of The North American Menopause Society.