Menopause can bring with it a number of disturbing symptoms, such as blisters, night sweats and sleep problems. Hormonal therapy promises relief.
But many women wonder whether to follow her or not. This is because the treatment – the subject of a recent meeting of a panel of experts convened by Food and Drug Administration (FDA, the administration for food and medicines) has long been wrapped in uncertainty.
Once, it was used by the routine. But in 2002, a study that tests a certain type of therapy was stopped prematurely due to increased risk of breast cancer and blood clots. These fears have persisted, even though subsequent studies have shown that the benefits of current hormonal therapies exceed the risks for many women.
“There is still a lot of confusion and a lot of fear,” said Grayson Leverenz, a 50-year-old woman from Durham, North Carolina, who has hesitated to follow the therapy, but is now happy to have done it.
More and more women give a second chance of hormonal therapy. But experts continue to disagree with how to present the advantages and disadvantages. The Panel convened by FDA emphasized the benefits and suggested the elimination of health warnings from some versions – which caused dozens of experts to ask for more consultations before making changes.
Doctors say that hormonal therapy is an excellent option for many, but not for all menopause women – and it is important to understand the nuanced reality of these treatments before deciding what is best.
How hormonal therapy works
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It treats the symptoms that occur when menstruation decreases and stops, which leads to an accentuated decrease in estrogen levels and progesterone.
One type is local vaginal estrogen therapy, in small doses. Because it is applied in the vagina, very little reaches the blood, and the risks are much lower. Doctors say it is a good option for women whose main problem is vaginal dryness.
Systemic therapy (for the whole body) includes pills, patches, sprays, gels or a vaginal ring that releases doses of hormones in the bloodstream, at levels high enough to have significant effects on symptoms such as blisters. Such systemic hormones include estrogens and progestogens.
Jennifer Zwink, a nurse from Castle Rock, Colorado, started using an estrogen patch more than a year ago and also has a sterile that offers her progesterone. The treatment takes the blisters, improved sleep and reduces joint pain and bloating.
“It’s not like a 100%magical wand,” she said. “But it certainly made a significant difference.”
The Menopause Society states that hormonal therapy can reduce the risk of cardiovascular disease if started in the first 10 years after the installation of menopause. It can also reduce the risk of type 2 diabetes and help maintain bone density for longer.
“It may have a decrease in bone density to 60 years, instead of 50 years,” explained Dr. Margeva Morris Cole, gynecologist-obstetrician at Duke University.
Hormonal therapy also has risks
When Leverenz first received the recipe for hormonal therapy, last year, he was worried about the risks he had heard – but in the end he decided: “I can no longer live.”
With a combination of three drugs, anxiety has reduced, sleep and improved, joint pain and buffets have disappeared.
“I feel like I’m myself again,” she said.
Doctors say many patients hesitate to try hormones, and they try to reassure them.
Women can only use estrogen therapy for seven years-and combined estrogen-protection therapy for three to five years-before the risk of breast cancer increases, according to Menopause Society.
The organization states that both types of therapy increase the risk of stroke, a risk that disappears after stopping. The risk of blood clots increases if hormones are given orally, but it can be lower if used in the form of patch, gel or spray.
“Many of these risks are small,” said Dr. Nanette Santoro, gynecologist-obstetrician at the University of Colorado. “And they must be balanced with the benefit of relieving symptoms.”
Age, medical history and duration of therapy are important factors. Many women are undergoing treatment for about five years, and those who have had a stroke or certain other conditions may be advised not to use it at all.
Debate on changing warnings on hormonal drugs
Doctors are divided on changing “black box” warnings from some hormonal treatments. All estrogen -based drugs still bear warnings on increased risk of stroke, blood clots and cognitive problems in women who use them.
Most of the doctors in the FDA expert panel prescribe these hormones or are involved in a pharmaceutical industry campaign that opposes these warning labels. A letter signed by 76 doctors and researchers claims that “eliminating warnings without adequate scientific evaluation puts patients in danger” and asked the Agency to organize a meeting with a consultative committee, with public hearing, before making a decision.
Meanwhile, doctors urge people to pay attention to misinformation, such as false statements on social networks that hormones would prevent dementia and ensure healthy old age.
“We cannot say that you will live longer and healthier just because you have taken hormones,” Cole said from Duke. “I do not want the balance to bow so much that people believe that treatment guarantees health for the next 30-40 years.”
Alternatives to hormonal therapy for menopause
Santoro mentioned a new non-hormonal drug, called fezolinent, marketed under the name of Veosah, for nocturnal buffets and sweats. Also, the antiepileptic drug gabapentin, in small doses, can be used for buffets, and a moisturizer can improve vaginal dryness.
Experts also say that regular physical exercises and a healthy diet can help manage symptoms, writes apnews.com.
Santoro warned against “uncontrolled proliferation” of supplements that claim to be miraculous solutions for menopause.
“Everyone wants to take advantage of the fever of menopause,” she said. “If it seems too nice to be true, it is likely that it is.”
