Decline in Hormone Use for Managing Menopause Symptoms

Understanding Hormone Therapy: A Vital Resource for Menopause Symptoms

Hormone therapy, which often comes in the form of pills or patches containing estrogen or a combination of estrogen and progesterone, has long been a trusted treatment for relieving menopause symptoms like hot flashes and night sweats. Despite its established safety and effectiveness, recent studies reveal a troubling trend: the number of U.S. women utilizing hormone therapy has significantly declined over the past years. Understanding the reasons behind this shift and the complexities of hormone therapy is crucial for women navigating menopause.

A Decline in Usage: The Statistics

According to a recent study presented at The Menopause Society’s annual meeting, only 1.8% of U.S. women over the age of 40 opted for hormone therapy to address menopause symptoms in 2023. This represents a notable decrease compared to 4.6% in 2007 and a slight dip to 2.5% recorded between 2007 and 2014. The findings highlight a concerning downward trend that spans across various age groups, particularly among women aged 45 to 49, 50 to 54, and 55 to 59—all demographics significantly affected by menopause symptoms.

Why Are Women Hesitant?

The study highlights several reasons for this decline in hormone therapy usage. Dr. Stephanie Faubion, medical director of The Menopause Society, noted that the exact reasons remain elusive; however, widespread skepticism about the treatment may be a contributing factor. The roots of this skepticism can largely be traced back to findings from the Women’s Health Initiative (WHI) in 2003, where initial results suggested that hormone therapy was linked to increased risks of heart disease and stroke, prompting many women to abandon the therapy entirely.

Further complicating the narrative, subsequent research indicated that the WHI data was skewed, as participants were predominantly over the age of 65 with pre-existing health conditions. Later assessments revealed that, when started within ten years of menopause and for women under 60, hormone therapy is generally safe.

The Mistrust and Misinformation

Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology, emphasizes a critical mistrust of pharmaceutical companies and medical professionals that lingers in many women’s minds. Moreover, a lack of comprehensive education regarding menopause among healthcare providers has exacerbated the issue. Many women in the perimenopausal stage, the transitional time leading up to menopause, may not even discuss their symptoms with healthcare providers, often seeking care only when they experience significant health issues.

Streicher also points out that many healthcare providers harbor the belief that hormone therapy should be a last resort, further discouraging discussions about this viable option.

Risks and Benefits of Hormone Therapy

The conversation surrounding hormone therapy must address both potential risks and benefits for those considering treatment. According to health professionals, the risks associated with hormone therapy do vary based on individual health factors such as age, ethnicity, BMI, and pre-existing health conditions.

Dr. Faubion outlines that while there is a small increased risk for breast cancer associated with the combination of estrogen and progestogen, this risk is likened to lifestyle factors such as obesity, alcohol use, and lack of physical activity. Interestingly, starting hormone therapy within ten years of menopause may have protective effects against dementia, challenging some previous assumptions about its safety.

Healthcare experts recommend discussing hormone therapy with a doctor, especially for women with a history of serious health issues like strokes, heart attacks, or hormone-dependent cancers, as these are generally contraindications for treatment.

The Role of Hormone Therapy in Menopause Management

Many studies conducted since the WHI findings affirm that hormone therapy can significantly improve menopausal symptoms. It can alleviate hot flashes, protect bone density, and reduce the risk of fractures. Dr. Faubion notes that starting hormone therapy early—in women under 60 and within ten years of menopause onset—can confer additional heart health benefits without raising safety concerns.

For women experiencing troublesome menopause symptoms, especially if they are within the appropriate age brackets and have no contraindications, hormone therapy might be a recommended course of action.

Navigating the Options: Finding Expertise

For women considering hormone therapy, consulting with a healthcare professional who specializes in menopause is essential. Dr. Shepherd suggests seeking out menopause educators who can explain the nuances of hormone options available, the methods of administration, and expected outcomes. The Menopause Society provides a database to help patients locate qualified practitioners.

For those who may not be suitable candidates for hormone therapy or who prefer alternative approaches, Dr. Faubion recommends exploring non-hormonal treatments such as the medication Veozah (fezolinetant), off-label options like antidepressants, and non-pharmaceutical interventions, including cognitive behavioral therapy and hypnosis.

Conclusion: Informed Choices for Menopausal Health

As the landscape of hormone therapy continues to evolve, it’s imperative for women to remain informed about their options, weighing the associated risks and benefits wisely. With the assistance of knowledgeable practitioners and access to the latest research, women can navigate their menopausal journey with confidence, ensuring that they make informed choices regarding hormone therapy and their overall health during this significant life transition.