“Menopause has the worst PR campaign in the history of the universe, because it’s not just about hot flashes and night sweats,” says Rachel Rubin, a sexual health expert and assistant clinical professor of urology at Georgetown University. The symptoms of menopause are more varied and can be more debilitating than many people realize. During the transition to menopause, women may also experience insomnia, mood swings, depression, weight gain, joint pain, vaginal dryness, and painful intercourse, among other symptoms. Bone loss accelerates. In women who are at genetic risk for Alzheimer’s disease, the first plaques are thought to form in the brain around this time.
An effective FDA-approved treatment for several of these symptoms, known as menopausal hormone therapy, has long existed, but due to fear and misinformation, very few women have a clear idea of its risks and benefits. The New York Times Magazine cover story this week examines hormone therapy and menopause, revealing what the research really tells us.
Hormone therapy relieves several symptoms of menopause and has some additional health benefits.
Hormone therapy has been shown to relieve hot flashes and disrupted sleep, and there is some evidence that it helps with depression and joint pain. It also helps prevent and treat menopausal genitourinary syndrome, a cluster of symptoms including urinary tract infections and pain during sexual intercourse that affects nearly half of postmenopausal women. Reduces the risk of diabetes and protects against osteoporosis. Due to the health risks associated with hormone therapy, it is recommended for women who have “bothersome” hot flashes and other symptoms of menopause, not for preventive care.
Hormone therapy carries health risks that vary by age.
The age at which a woman starts hormone therapy is important in assessing her increased risk of heart disease, stroke, and dementia.
Your questions about menopause, answered
For women going through early menopause, before age 45, hormone therapy is recommended because they are at increased risk of osteoporosis if they do not receive hormones until the typical age of menopause. For healthy women in their 50s, the increased risks of hormone therapy are considered low. There are higher risks for women who start hormone therapy after age 60. Definitive research on women starting at 50 and continuing into their 60s has yet to be done.
Women of all ages are at increased risk of breast cancer after about five years of taking hormones.
Those most at risk from hormone use are women who have had a heart attack, breast cancer, or stroke or blood clot, or women with a host of significant health problems.
“For everyone else,” says Stephanie Faubion, director of the Center for Women’s Health at the Mayo Clinic, “the decision has to do with severity of symptoms, as well as personal preference and tolerance level for risk”.
Hormone therapy fears are based primarily on an important but flawed study from 2002.
Hormone therapy was once the most frequently prescribed treatment in the United States, but in 2002, a major study raised serious concerns about its health risks, causing many doctors and patients to abandon it. New analyzes of the data from that study, known as the Women’s Health Initiative, along with many others, have since ensured that the risks of hormone therapy are low for healthy women under age 60. But the treatment’s reputation has yet to recover.
Menopause is little studied and taught.
If many doctors don’t discuss hormone therapy with their patients, it may be due to gaps in their own knowledge. A 2017 survey sent to resident physicians across the country found that 20 percent of them had not heard a single lecture on the topic of menopause. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes that menopausal women have generally been underserved, an oversight she considers one of medicine’s great blind spots. “This suggests that we have a high cultural tolerance for women’s suffering,” says Thurston. “It’s not considered important.”
Hormone therapy is not the only option.
For high-risk women, there are other sources of relief: The selective serotonin reuptake inhibitor (SSRI) paroxetine is approved for relief of hot flashes, although it is not as effective as hormone therapy. Cognitive behavioral therapy has also been shown to help women control how much hot flashes bother them. Doctors treating menopause are awaiting FDA review of a drug due to be approved this month: a non-hormonal drug that would target the complex of neurons thought to be involved in triggering hot flashes.
Women should talk to their doctors about their symptoms and treatment options. The North American Menopause Society, an association of menopause specialists, offers a resource that allows users to search by zip code for health professionals who have received a NAMS certification in menopause care.