More women with debilitating menopausal symptoms should be offered the option of hormone therapy, according to an article published Monday in the Canadian Medical Association Journal.
“There are a large number of symptoms of menopause and perimenopause, some of which can be extremely debilitating, especially for relatively young women these days,” points out Dr. Iliana Lega, an endocrinologist at Women’s College Hospital in Toronto and the main author of the article. “Every day we see how few women are educated about menopausal symptoms and treatment options. We just think there is a need for better education on this subject,” he said.
Older women in their 40s and 50s are raising children and could be at the peak of their careers, but live with distressing symptoms. “Having trouble sleeping, frequent hot flashes, irritability and mood issues have a huge impact on their daily lives,” Dr. Lega recalls.
Menopausal hormone therapy, also known as hormone replacement therapy, has been a controversial issue since the 1990s, when a major study found an association with higher rates of breast cancer and stroke. But many experts now say the study overstated the risks, which were primarily associated with women over the age of 60 — when the risks of these conditions would increase with age anyway.
Dr. Lega and her coauthors reviewed more recent studies and found that the risks are much lower for women in their 40s and 50s, especially if they use hormone therapy for five years or less.
For women who are between the ages of 50 and 59 or who start hormone therapy within 10 years of their last menstrual period, “the higher risk of breast cancer is estimated at three additional cases per 1000 women who use combined hormone therapy for menopause. for five years.
“Combined” hormone therapy for menopause is a mixture of estrogen and progestin.
The review also found that the risk of stroke for people under 60 using hormone therapy was very low.
“Certainly among women over 60, the discussion is very different,” Iliana Lega points out. “Usually this is not an age group for which initiation of hormone therapy is recommended. »
The position paper is not intended to suggest that all women should take menopausal hormone therapy, but to give healthcare providers the information they need to discuss options with patients and weigh the risks and benefits on a individual basis.
Dr. Iris Gorfinkel, a Toronto family physician who was not involved in the article, agrees. To assess the potential for harm, she discusses with her patients the possible presence of a gene mutation that is associated with a higher risk of breast cancer, as well as family history.
She does the same to assess the risk of heart disease or stroke, discussing family history and other factors such as smoking, diabetes and high blood pressure.
On the other side of the scale, it is important not to underestimate the degree of suffering the patient feels because of the symptoms of menopause. “The patient may be aware that it could be ‘life changing’, but many patients don’t know that the perimenopausal years can last a decade,” she recalls. “The symptoms are getting worse and worse.”
Menopausal hormone therapy is up to 90% effective in treating hot flashes and improving sleep quality and mood disorders, according to the position paper. It also helps prevent loss of bone density.
This is a significant benefit, observes Dr. Gorfinkel, “because life changes instantly when women or men fall and break a hip.”
Hormone therapy is taken in pill or patch form to manage these symptoms. But if someone just wants to treat a localized symptom, like a dry vagina, hormone therapy can be given through a topical lotion, which eliminates any increased risk of breast cancer, says Iris Gorfinkel.
The Canadian Cancer Society recommends caution when considering menopausal hormone therapy.
“The Canadian Cancer Society recommends that women avoid taking HRT (hormone replacement therapy) for any reason other than the relief of severe menopausal symptoms that have not responded to other treatments,” a statement read. on its website. “If you and your doctor decide HRT is appropriate, the lowest effective dose should be used for the shortest time possible. »
Dr. Melinda Wu, general practitioner in oncology at Women’s College Hospital’s Breast Centre, says the Cancer Society’s view aligns with the review article’s findings that not all women should undergo treatment hormone replacement, but they should be aware that this is an option to be discussed with their doctors. “It always comes down to a discussion of the risks and benefits.
