Introduction
Menopause, a natural phase in a woman’s life, has often been shrouded in myths and misconceptions. One area that has sparked considerable debate is the use of menopausal hormone therapy (MHT). Over two decades ago, the Women’s Health Initiative (WHI) study raised concerns about the safety of MHT, leading to widespread fear among women and healthcare professionals. However, recent research suggests that these fears may have been largely overblown.
In this article, we delve into the renaissance era of menopause management, focusing on the use of MHT beyond age 65 years and its effects on women’s health outcomes. Several new developments have occurred since May 1st, 2024! We are living in a very exciting time for menopause care.
The WHI Legacy
The WHI study, conducted in 2002, sent shockwaves through the medical community. It linked MHT to increased risks of invasive breast cancer, stroke, and coronary heart disease. As a result, many women discontinued MHT, especially after age 65, fearing these potential health hazards. However, subsequent studies have provided a more nuanced perspective.
Can We Continue MHT Past Age 65?
On May 1st, the journal Menopause published a large-scale study, based on the records of 10 million senior Medicare women from 2007 to 2020, shedding light on the implications of MHT use beyond age 65. Here are the key findings:
Type Matters: The effects of MHT vary significantly by type. Estrogen monotherapy beyond age 65 was associated with significant risk reductions in several health outcomes, including mortality, breast cancer, lung cancer, colorectal cancer, congestive heart failure, venous thromboembolism, atrial fibrillation, acute myocardial infarction, and dementia.
Combination Therapy: The use of a combination of estrogen and progestogen therapy increased the risk of breast cancer. However, this risk can be mitigated by using low doses of transdermal or vaginal estrogen plus progestin. This increased risk is also lower than the increased risk of breast cancer observed in women who routinely drink two glasses of wine per day.
Individualized Approach: There is no one-size-fits-all rule for stopping MHT based on age alone. For healthy women experiencing persistent hot flashes, continuing MHT beyond age 65 can be a reasonable option with appropriate counseling and regular risk-benefit assessments.
Route of Administration: As women age, choosing low-dose and nonoral routes of administration becomes crucial. Transdermal or vaginal estrogen may offer benefits while minimizing risks.
Debunking the Fear
Also on May 1st, the authors of the WHI published a 20 year follow up to their original study in the Journal of the American Medical Association. They agreed with the conclusion that many menopause specialists have since reached, which is that the interpretation of their original study was deeply flawed. Contrary to the initial alarm, the evidence suggests that MHT can be safe and effective for managing menopause symptoms. Younger menopausal women, especially those under 60, stand to benefit from MHT. Hot flashes, night sweats, and other bothersome symptoms can be alleviated without undue risks.
What Does Halle Berry Have To Do With Menopause Care?
On May 2nd, Oscar-winning actor and women’s health activist Halle Berry took a bold step to destigmatize menopause. She joined a group of bipartisan senators to push for legislation that would allocate $275 million toward research and education around menopause. This significant hormone shift that women experience in middle age deserves attention and investment. The bipartisan Senate bill, known as the Advancing Menopause Care and Mid-Life Women’s Health Act, aims to create public health efforts to improve women’s mid-life health.
Conclusion
Menopause is no longer a time of fear and uncertainty. Armed with evidence-based information, women can confidently navigate this transformative phase. As we embrace the renaissance era of menopause management, let’s dispel myths, empower women, and prioritize individualized care.
Call your senators today and ask them to support this bill!
Phases Clinic is now accepting patients for comprehensive menopause care in Washington State, including hormone therapy and hypnotherapy via telehealth and home health.
Sources:
Baik SH, Baye F, McDonald CJ. Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses. Menopause. 2024 May 1;31(5):363-371. doi: 10.1097/GME.0000000000002335. Epub 2024 Mar 9. PMID: 38595196.
Manson JE, Crandall CJ, Rossouw JE, Chlebowski RT, Anderson GL, Stefanick ML, Aragaki AK, Cauley JA, Wells GL, LaCroix AZ, Thomson CA, Neuhouser ML, Van Horn L, Kooperberg C, Howard BV, Tinker LF, Wactawski-Wende J, Shumaker SA, Prentice RL. The Women's Health Initiative Randomized Trials and Clinical Practice: A Review. JAMA. 2024 May 1. doi: 10.1001/jama.2024.6542. Epub ahead of print. PMID: 38691368.
Cimons, M. (2024, May 1). No need to fear menopause hormone drugs, finds major women’s health study. The Washington Post
Seitz, A. (2024, May 2). Halle Berry joins senators to push for menopause research funding. The Associated Press. Retrieved from https://apnews.com.
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