MediCal
Q&a
hot News flash—
MeNopausal horMoNe therapy
QMy doctor says I have to stop my estrogen hormone therapy because I’m turning 55, and “it’s time” for me to transition to a lower
Paula corrigan
Md, MPH
hormone state. I started the hormone therapy because I had terrible
hot flashes, five years ago, and emotionally I was a mess. The estrogen made a huge difference,
and I could go back to work and felt stable. I can’t imagine being without it. Must I give it up?
Menopause occurs at a mean age of 51, with most women
becoming menopausal between the ages of 45 to 55 years. Estrogen is the most effective treatment for relief of menopausal symptoms to include hot flashes, vaginal dryness, urinary
symptoms and emotional lability. Many women who start hormones for post-menopausal symptoms are able to taper off after a few years without return of their symptoms. If the symptoms do return, then extended use may
be reasonable if you and your doctor feel
the benefits of symptom relief outweigh
the risks associated with treatment.
The Women’s Health Initiative was a
study conducted about 10 years ago to
determine if estrogen therapy (with or
without added progesterone) in post-menopausal women would reduce the
risk of cardiovascular events. The studies were stopped early due to increased
risk of stroke, breast cancer, heart disease, gallbladder disease and blood clots
seen in those who were treated versus
those on placebo. Since this time, the
use of menopausal hormone therapy has
been significantly less due to concern
over the risks of therapy. It has been noted that the population of women in this
study were older (average age 63), with
50 percent being past or current smokers, so the data may not apply to a younger, healthier post-menopausal population.
Current studies are looking at younger women, and also dif-
ferent types and dosages of medication. Therefore, for young
(age 50-59), symptomatic, post-menopausal women, short-
term treatment with hormone therapy is considered to be a
reasonable option, with the goal to taper off the medication
as soon as possible. It is best to use the lowest possible dose of
medication that will control symptoms, such as 0.3 mg of con-
jugated estrogens or 0.5 mg of estradiol. Short term treatment
is considered to be two to three years and generally not more
than five years. Only a minority of women who are unable to
taper the medication without persistent symptoms should con-
sider extended use of estrogen therapy. Women with known
coronary heart disease, breast cancer, previous venous blood
clots, stroke, or active liver disease would not be considered
good candidates for menopausal hormone therapy. Some of the
beneficial aspects of hormone replacement therapy are preven-
tion of osteoporosis, reduced risk of colon cancer, and possibly
reduced risk of adult diabetes.
The [estrogen therapy]
studies were stopped
early due to increased
risk of stroke, breast
cancer, heart disease,
gallbladder disease
and blood clots seen
in those who were
treated versus those
on placebo.
