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Fear of Missing Out (FOMO) on the Benefits of HRT

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Dr. Michael Green
Medically Reviewed byDr. Michael GreenMD, OB/GYN Chief Medical OfficerRead Bio
Written ByNancy BelcherPhD

This often misrepresented treatment could save many lives.

It isn’t just one thing that tells you something is wrong, it’s the whole combination of symptoms. Forgetfulness, irregular or extra heavy periods, weight gain in new places, or maybe an unusual feeling of depression. But in your late 30s or early 40s, it's hard to imagine it is menopause - already? 

We are hearing from women about the benefits of hormone replacement therapy (HRT). Their stories are similar: before menopause they were training for sporting events, or leading teams with energy and excitement and then seemingly overnight they could barely get out of bed. This drop-in energy was likely due to a new state of chronic insomnia brought on by menopause. Additionally, anxiety was heightened, demeanor became moody, and both work and home life were suffering as a result of untreated menopause symptoms.

What many people (including doctors) don’t understand is that when women have undiagnosed and/or untreated perimenopause there can be many significant side effects that lower the quality of a woman’s (and her family’s) life. Perimenopause can begin as early as your late 30s. By your mid-40s, you are most likely suffering from low levels of hormones estrogen, progesterone, and testosterone. This drop in hormones eventually causes the ovaries to stop producing eggs and your periods will stop.

Why Can’t I Get the Help I Need?

Seeking help from your doctor can sometimes be fruitless - they often suggest these symptoms and changes are ‘normal’ and/or due to stress, age, life circumstances and to just “put up with it.”  Some suggest eating better and exercising more, while others will prescribe antidepressants or anti-epileptics, which do not treat the cause of the problem, hormone deficiency. 

A safe, effective treatment exists for most menopause symptoms, hormone replacement therapy (HRT). But as a result of misinformation and scaremongering, millions of women are missing out on this treatment.

About 70-80% of women experience menopause symptoms which on average last 7.5 years or longer, and for 25% it is debilitating.1 After one year without a period, a woman is considered menopausal. The symptoms of menopause can include vaginal changes, weight gain, hot flashes, depression, aches and pains, insomnia, anxiety, and transient memory loss.

Menopause harms women’s bones, brains, hearts, and immune systems. It is associated with a higher risk of osteoporosis and bone fractures, increased abdominal fat, and a heightened risk of getting Type 2 diabetes. These hormonal changes of menopause can also lead to women aging faster. The hormonal changes speed up cellular aging by about 6%. 1

Estrogen is particularly important in maintaining women’s heart health. We know that before a woman reaches menopause her likelihood of suffering from a heart attack is less than a man, but after menopause when estrogen levels are very low, the risk of a woman having a heart attack increases as the elasticity of the coronary arteries decreases.

A Brief HRT History

In 1966 Dr. Robert Wilson  wrote “Feminine Forever.”  Dr. Wilson argued that women’s loss of hormones after menopause gives rise to a serious, painful, and often crippling illness, and a regular course of estrogen supplements or hormone replacement therapy (HRT) was the solution. Dr. Wilson went so far as to say that HRT would preserve women’s youth, sex appeal, and marriages. 

While the book sparked quite a debate on both sides of the issue, by 2000 HRT was extremely popular. Before 2001, about 20% of post-menopausal women used HRT. The benefits were clear - it offered relief from the miserable symptoms of menopause and prevented many chronic diseases including osteoporosis and bone fractures. 

Women liked that it stopped their skin thinning by boosting collagen levels in the skin. Many have suggested that it also reduced cognitive decline. But most importantly, it was shown to prevent the onset of cardiovascular disease—still the biggest killer of women.

In 1997 the Journal of the American Medical Association (JAMA) published a scientific report that concluded that HRT extended life expectancy for postmenopausal women by as much as three years, and it had become a standard treatment. 3 Then a study from 2002 came out...

The Unscientific Hormone Scare

In 2002, the results of a large randomized trial known as the Women’s Health Initiative (WHI), were rushed into publication before they properly analyzed the data. Numbers sound impressive and authoritative. However, when researchers publish data when it isn’t ready for prime time it is easy for statistics to mislead consumers. That’s what happened with the WHI. 

The first WHI study results concluded that taking HRT increased women’s risk of breast cancer, heart attacks, strokes, and blood clots. Women were told by this one study that the dangers of HRT mostly outweighed any benefits.2

These findings flew in the face of decades of research on HRT and overturned decades of medical practice. While HRT use increased rapidly during the 1990s it dropped by 50% in the early 2000s,  and within six years fewer than 5% of US post-menopausal women were taking HRT.1  Even now, 20 years after the misleading study was released, doctors are reluctant to prescribe hormones to their patients.

The conclusions of this initial WHI study, which so many people still cite, are almost entirely wrong. The study was designed to look at strategies for preventing heart disease, cancer, and osteoporosis in women as they age. But instead of recruiting healthy women in their 40s and early 50s, who were entering menopause, the median age of women in the first WHI study was 63. These older recruits were already unhealthy. How were they unhealthy?

  • Most had been suffering from hormone deficiencies for decades,

  • Half were obese,

  • Nearly 50% were current or past smokers, and 

  • More than a third had been treated for high blood pressure. The women included in the study probably were already suffering from atherosclerosis—where plaque builds up inside arteries and makes heart disease more likely.

Today, even the scientists behind the original WHI are saying that the 2002 analysis showed that offering older and more unhealthy women HRT isn’t a great idea, but offering it earlier to prevent diseases is good medicine. The original WHI provided no information about the women that the HRT treatment was aimed at - women 40-60 years of age. We know that women over 60, who have never been on HRT, should probably not take HRT.

Other problems with WHI

The original WHI almost completely excluded women who were experiencing menopausal symptoms. If a woman was having hot flashes, she could not be in the study! But these are the very women who would be expected to benefit most from the preventive effects of HRT. We now know, from a more current and thorough research, that hot flashes and night sweats are associated with an increased risk of heart attack and stroke, and that HRT is the most effective treatment.

Don’t Miss Out

It is now clear that the long-term benefits of HRT as women enter menopause are significant. A careful reanalysis of the WHI studies has conclusively shown that women in their 50s were actually 31% less likely to die in the five to seven years that they were taking hormones.1 For women who have had their uterus removed or who start menopause before the age of 45, HRT can be life-saving, preventing osteoporosis and heart disease for as long as 18 years.

Taking HRT reduces the mortality of women aged 50-59 by 20-40%, mostly because they suffer fewer heart attacks. If we weigh the risks, here’s what we know about women’s general life expectancy and unrelated to HRT treatment:

  • One in 25 women will die of breast cancer,

  • One in 3 will die of coronary heart disease, and 

  • One in 6 will die of a stroke.

Importantly, if women are on HRT at the time of their breast cancer diagnosis they are less likely to die from the disease, and 90% of women that get breast cancer, survive in wealthy countries. Weighing such risks is part of the decision about whether to embark on a course of HRT.

Where are we today?

The original WHI study was flawed and has been re-evaluated with the data showing the benefits of HRT. Equally important points include the fact that Winona does not use the type of hormones used in WHI. Winona provides bioidentical hormones made from yams, NOT Premarin which came from pregnant horse urine. Winona’s bioidentical hormones that are used in HRT have shifted the scientific consensus on the treatment’s effects, and the estrogen and progesterone that are offered are FDA approved, safe and effective. 

Sadly, HRT remains in a type of medical limbo. Doctors who are unfamiliar with bioidentical hormones, or maybe haven’t kept up with the current scientific literature, are leading women astray causing women in their 40s and 50s to lose out on the long-term health benefits that HRT can provide. 

In the absence of prescribed hormone therapy, some women turn to ‘natural remedies’ which will not reduce a woman’s future risk of a heart attack, and may actually be dangerous. Some types of black cohosh, a popular herbal supplement, have been associated with liver poisoning. By shunning HRT because of an old, outdated, poorly conducted study, some women are harming themselves in the short and long term.

The window of opportunity to begin HRT to capture its full benefits—including resisting the effects of cognitive decline—is short. Don’t miss out. Winona’s licensed, and female-focused physicians can prescribe personalized amounts of three hormones: estrogen, micronized progesterone, and testosterone (DHEA).

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

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