06-21-2023 Primetime Living - Flipbook - Page 24
24 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, June 21, 2023
Menopause, continued
from page 8
are having a negative effect on their lives,
both at home and at work. Over the past
two decades, there has been a huge
amount of confusion regarding hormone
replacement therapy (HRT). We now have
clear, evidence-based guidelines available
to ensure women have individualized care
and treatment for their perimenopause
and menopause.”
Unfortunately, too many people, health
care professionals and patients alike, are
still concerned with perceived risks generated by a decades old study that we
now know was flawed. The goal here
is to reassure those for whom hormone
replacement therapy could help ameliorate any discomforts related to menopause, to learn about other options when
appropriate, and to be open to a discussion with their medical professionals.
Definitions
Let’s start with some definitions.
“Menopause is an all-inclusive term
and includes perimenopause, menopause and post-menopause,” explains
Dr. Wen Shen, M.D., M.P.H., Co-Director
of the Women’s Wellness & Healthy
Aging Program (WWHAP) and Associate
Professor of Gynecology and Obstetrics
at John Hopkins School of Medicine.
Dr. Shen has concentrated on menopause medicine for more than 15 years. In
addition to clinical care, Dr. Shen focuses
on educating her patients, other physicians and future physicians on women’s
post reproductive health. She is engaged
in clinical trials for new therapies for the
treatment of menopause symptoms and is
actively developing curricula and educational aids for future physicians and health
care providers on menopause medicine
and the importance of healthy aging.
“Perimenopause,” says Shen, “is the
time between the approximate ages 40 to
51 when most women will start experiencing irregularities in their periods as their
hormone levels fluctuate. Ovarian function
goes through a roller-coaster stage. As
women enter this period, their symptoms
will differ. Some breeze through it with
no problems. For others, the turbulence
of varying estrogen levels affects them
strongly, so symptoms tend to be all over
the place. Hormone replacement therapy,
where appropriate, can return them to a
normal life.
“Once they pass 12 consecutive spontaneous months without a period, they are
post-menopausal and remain there for the
rest of their lives. For women who have
had a hysterectomy and/or an oophorectomy, you have to measure hormone levels using an FSH test (follicle stimulating
hormone) to determine the inactivity of the
ovaries in producing estrogen. This test
guides the physician on the stage they
are in and how to address the patient’s
symptoms.
“Approximately two-thirds of women
live to be 85 years old, so they will spend
a third of their lives in post-menopause,
a very important part of a woman’s life.
At the age of 50, many are still active
professionally, involved with their families,
participating in activities, living a full life.
They often have no plans to stop doing
any of this.”
Estrogen receptors are located in the
tissues of the female reproductive tract
and breast as one would expect, but also
in tissues as diverse as bone, brain, liver,
colon, skin, and salivary gland.” As ovaries stop producing estrogen, bone, brain
and vaginal functions change.
What perimenopausal symptoms do
women experience? “The most familiar
are vasomotor symptoms – hot flashes
(or flushes) and night sweats,” says Shen.
“Despite all the jokes, they are not funny.
They are incredibly serious as women
feel like they are having panic attacks,
palpitations and a strong sense of anxiety.
These dramatic changes are related to the
body’s thermostat and can be extremely
uncomfortable, annoying and disturbing.
Night sweats disrupt sleep and, in turn,
severely impact the quality of their lives
as their cognitive function is threatened.
Many women also suffer from vaginal
atrophy, a part of the body with a lot of
estrogen receptors. This can lead to bladder problems and painful intercourse.”
Other body changes? “Although less
obvious,” Shen adds, “the loss of estrogen can cause serious medical issues
including an increase in cardiovascular
disease and an increased risk of heart
attacks. After the age of 65, more women
die of heart disease than men. One of
three women will have an osteoporotic
event in her lifetime, such as a fragility
fracture, which does not heal well. This
compromises the quality of life due to
increased frailty and decreased mobility. It
also takes a real toll on the families.
“However, one change that causes
fear is cognitive decline. As with vaginal
tissue, the brain has a lot of estrogen
receptors. Women are more prone to
Alzheimer’s disease, and there is a greater
risk for early onset dementia for women
who experience early menopause.”
A Brief History of Hormone
Replacement Therapy
The Women’s Liberation Movement
of the 1960s – the genesis of feminism
– changed how women perceived themselves. Feminine Forever, a 1966 book
by R.A. Wilson, claimed “menopause is a
hormone deficiency disease, curable and
totally preventable, just take estrogen.”
An article from Medicina, published in
the National Library of Medicine, explains
“the real impact of hormone depletion on
women’s health. The clinical conditions
associated with menopause were identified as “Hormone Deficiency Syndrome,”
which included, besides hot flashes,
other late onset chronic diseases such
as osteoporosis, cardiovascular events,
Alzheimer’s disease, and vaginal atrophy.
At the beginning of the 20th century,
the Food and Drug Administration (FDA)
approved an estrogen product, Premarin,
for the treatment of hot flashes.”
In the 1970s, Hormone Replacement
Therapy (HRT) added progestin – a form
of progesterone that plays a role in menstrual cycles and pregnancy – to estrogen
for women with uteruses to prevent endometrial cancer. Women who had hysterectomies continued to take ERT (Estrogen
Replacement Therapy). In 1988, the FDA
approved HRT/ERT to prevent osteoporosis. By the mid-1990s, approximately
40% of American women were taking
hormone therapy, making it one of the
most commonly prescribed medications
at the time.
An early trial of HRT, the Heart and
Estrogen/Progestin Replacement Study
(HERS), which studied women with coronary heart disease, showed conflicting
results. During the first year, those taking
HRT had an increase in non-fatal coronary events. After four years, that number
decreased and showed there was no
difference in the HRT group versus those
receiving placebos.
A majority of other studies continued to show benefits to HRT. Then, in
1998, the Women’s Health Initiative study
began.
Women’s Health Initiative
Twenty-one years ago next month,
one of the largest, most expensive studies ever undertaken of post-menopausal
women – costing around $1 billion – made
headlines around the world. The Women’s
Health Initiative (WHI), funded by the
National Heart, Lung, and Blood Institute
(NHLBI), shocked the world with frightening headlines stating, “Hormone Therapy
Causes Breast Cancer” and “Hormone
Therapy Causes Coronary Heart Disease.”
As you can imagine, people are drawn to
negative news more than positive news.
In the ensuing months, prescriptions for
ERT and HRT dropped 70%.
After further reviews of the data from
the WHI and the study as a whole, these
statements were far from accurate. Within
a few short years, papers filled the medical journals, pointing out the inaccuracies,
but they never received the same level of
publicity and awareness the WHI statistics did. Even today, many doctors are
reluctant to prescribe HRT/ERT.
In one paper, titled A Critique of
Women’s Health Initiative Studies (20022006), published in 2006, the author says,
“In contrast to the conclusions reached by
the WHI and the NHLBI, I conclude that
treatment of post-menopausal women
with estrogen and progestin (Prempro)
does not increase the risks of cardiovascular disease, invasive breast cancer, stroke or venous thromboembolism.
I also disagree with the claim that an
increased risk of stroke existed in women
treated with estrogen alone. Note that
these increases were judged in the final
analyses to be statistically insignificant.”
Even the NIH National Institute on
Aging says the WHI study had problems:
“…research reported since then found
that younger women are at less risk and
have more potential benefits than was
suggested by the WHI study. The negative
effects of the WHI hormone treatments
mostly affected women who were over
age 60 and postmenopausal. Newer hormone formulations seem to have less risk
and may provide benefits that outweigh
possible risks for certain women during
