Menopause is natural, and understanding hormone use during menopause can bring relief to women during the seven-to-14-year transition.
“Menopause is normal. Menopause is natural,” said Patricia Geraghty, FNP-BC, women’s health nurse practitioner and the medical director of Each Woman’s Health in Walnut Creek, California. “There’s nothing wrong with menopause.”
Gold standard
“Hormones are such a beneficial thing for women,” said Geraghty, a member of the HealthyWomen Women’s Health Advisory Council. She calls hormones the gold standard for treating menopause issues, including sleep disruption, disabling hot flashes, and moodiness.
In the 90s, hormone therapy for menopause was popular but controversial. A randomized controlled trial of 32,000 women looked at whether hormones should be used lifelong. Half the women in this study received a placebo and the other half were given conjugated equine estrogen and a synthetic progesterone. The study was stopped early because researchers saw an increased risk of breast cancer in women who were taking the estrogen plus progestin.
However, Geraghty said those women who had the increased risk were a median age of 63 — well past the menopause transition. “The problem is that data was extrapolated to all hormones that are harmful,” she said, noting it’s “an extreme example of taking data from one group and applying it to a different group.”
Understanding hormones
Hormones can help women manage symptoms during menopause, such as hot flashes, disrupted sleep, racing brain, fatigue, and moodiness.
While hot flashes are normal and temporary, they can interfere with some women’s lives. Geraghty sayid many women, including Black women and overweight women, may start experiencing hot flashes before their respective periods actually stop. Hot flashes can linger too. She says 42% of women ages 60 to 64 still have hot flashes and night sweats.
Geraghty said women should consider weaning off of hormones or stopping them about 10 years from menopause or by age 59. She also said women who have a uterus can use estrogen and progesterone to protect their uterus, but there’s a risk of breast cancer when it’s used for a long time. Looking at recent data, she sayid women who’ve had hysterectomies were given estrogen only for seven years because they didn’t need the progesterone to protect their uterus. They’ve been followed for 18 years and have no increased risk of breast cancer. Women using estradiol and progesterone don’t have an increased risk of breast cancer until after six years.
Still, the biggest risk of an adverse event from hormone use is a blood clot. But she explains that typically women in their 50s don’t have a very high baseline risk for blood clots. Plus, with transdermal dosing, such as a patch, gel, or spray, the risk of blood clots from hormones is eliminated.
Continuing education
Geraghty wants patients and clinicians to be informed about menopause. One of the biggest challenges is how little medical professionals are taught about the topic.
“There’s a tremendous amount of undereducation on menopause in medical schools,” she said. “The median amount of time teaching menopause in the curriculum is one hour. So, women really have trouble finding someone that can be informed to provide them care.”
That’s why she wrote and edited the book “Each Women’s Menopause: An Evidence Based Resource,” which is directed at healthcare providers. “I want them to be at least aware, and then we need to facilitate them acquiring the information.”