David Baxter PhD
Late Founder
Risks often exaggerated in hormone therapy option
By Chris Zdeb, Canwest News Service
May 7, 2009
Leslie Belanger's extensive reading about menopause and the fact she's had hormone treatment twice have made her something of an expert at YMCA, where she teaches swimming.
"I find I'm better educated than a lot of women, and when I start talking in the change room, a lot of them ask me questions because they want to know more," says Belanger, 53.
She thinks their thirst for knowledge reflects the mystery that surrounds hormone treatment even though it's been around since the 1930s.
Hormone therapy is the use of certain drugs -- estrogen alone or in combination with a progesterone or an androgen (a form of testosterone) -- to treat hot flashes and other physical changes women experience in menopause.
It used to be called hormone replacement therapy, but the word replacement was recently dropped because the treatment never literally increased hormones to premenopausal levels. It simply treats the symptoms of menopause, says Dr. Tami Shandro, a physician with two provincial menopause clinics based in Edmonton.
Estrogen has been prescribed since the 1930s and hormone treatment was widely used until 2002. That year, a Women's Health Initiative study suggested estrogen and progestin (a synthetic hormone similar to progesterone), increased a healthy woman's risk for breast cancer, stroke, heart attack and blood clots. Suddenly women everywhere stopped taking hormones and doctors stopped prescribing them.
At 52, Belanger was experiencing just about every menopausal symptom, including hot flashes, and was starting to have problems with her memory. Her doctor acknowledged that she was going through menopause, told her it was natural and that her estrogen was low, but the doctor didn't feel comfortable putting her on hormone therapy.
Belanger persisted until she was referred to Shandro. Within days of being prescribed hormones, Belanger's symptoms disappeared.
Many doctors and patients are still spooked by the 2002 study, but those first alarming media reports didn't tell the whole story, Shandro says.
What didn't come out at the time was that the study focused on women in their 60s and 70s, who may react differently to HT than women in their 40s and 50s, Shandro says.
Also not reported was that the slight increase in risk of breast cancer is smaller than the risk posed by things women do every day without thinking, such as drinking alcohol or not exercising, she adds.
"I think the risks of HT, which works in 90% of cases, have been somewhat overrated and women should at least apprise themselves of the information so they can make a good decision," she says. She suggests Menopause, NAMS -Menopause Information and Help as a good source. Belanger says she is very pro-hormone-therapy, but can see the skepticism in friends' faces when she tells them this. "A lot of women out there are still leery."
Up to 80% of menopausal women and 50% of those in perimenopause (the start of "the change," lasting as long as 10 years and leading to menopause, the cessation of menstruation) experience some symptoms, says Shandro. Besides hot flashes, symptoms include fatigue, weakness, weight gain and loss of sex drive.
For most, symptoms are mild to moderate and usually last six months to two years after menopause (defined as 12 months without a period).
But about 10 to 15% experience symptoms so severe, and over such an extended period -- six to 10 years for 25% of women; more than 10 years for 10% -- that they seek medical help.
Some women don't seek help because they see menopause as a natural, normal part of aging that shouldn't be treated like a disease, she adds. All of her reading prompted Belanger to ask Shandro for bioidentical synthesized hormone therapy -- pharmaceutical products made from plants, but that are identical to the estrogen and progesterone produced by the body. BHTs have been used at the menopause clinic for 10 years.
"We don't know that they're better or safer (than the synthesized hormones that have been used for many, many years), but generally people have this sense that they might be better," Shandro says.
Proof of their efficacy could come in 2010 or 2011 when studies on BHT are complete and the findings made public. Until then, women who come to the menopause clinics are presented with all their options and given a choice.
By Chris Zdeb, Canwest News Service
May 7, 2009
Leslie Belanger's extensive reading about menopause and the fact she's had hormone treatment twice have made her something of an expert at YMCA, where she teaches swimming.
"I find I'm better educated than a lot of women, and when I start talking in the change room, a lot of them ask me questions because they want to know more," says Belanger, 53.
She thinks their thirst for knowledge reflects the mystery that surrounds hormone treatment even though it's been around since the 1930s.
Hormone therapy is the use of certain drugs -- estrogen alone or in combination with a progesterone or an androgen (a form of testosterone) -- to treat hot flashes and other physical changes women experience in menopause.
It used to be called hormone replacement therapy, but the word replacement was recently dropped because the treatment never literally increased hormones to premenopausal levels. It simply treats the symptoms of menopause, says Dr. Tami Shandro, a physician with two provincial menopause clinics based in Edmonton.
Estrogen has been prescribed since the 1930s and hormone treatment was widely used until 2002. That year, a Women's Health Initiative study suggested estrogen and progestin (a synthetic hormone similar to progesterone), increased a healthy woman's risk for breast cancer, stroke, heart attack and blood clots. Suddenly women everywhere stopped taking hormones and doctors stopped prescribing them.
At 52, Belanger was experiencing just about every menopausal symptom, including hot flashes, and was starting to have problems with her memory. Her doctor acknowledged that she was going through menopause, told her it was natural and that her estrogen was low, but the doctor didn't feel comfortable putting her on hormone therapy.
Belanger persisted until she was referred to Shandro. Within days of being prescribed hormones, Belanger's symptoms disappeared.
Many doctors and patients are still spooked by the 2002 study, but those first alarming media reports didn't tell the whole story, Shandro says.
What didn't come out at the time was that the study focused on women in their 60s and 70s, who may react differently to HT than women in their 40s and 50s, Shandro says.
Also not reported was that the slight increase in risk of breast cancer is smaller than the risk posed by things women do every day without thinking, such as drinking alcohol or not exercising, she adds.
"I think the risks of HT, which works in 90% of cases, have been somewhat overrated and women should at least apprise themselves of the information so they can make a good decision," she says. She suggests Menopause, NAMS -Menopause Information and Help as a good source. Belanger says she is very pro-hormone-therapy, but can see the skepticism in friends' faces when she tells them this. "A lot of women out there are still leery."
Up to 80% of menopausal women and 50% of those in perimenopause (the start of "the change," lasting as long as 10 years and leading to menopause, the cessation of menstruation) experience some symptoms, says Shandro. Besides hot flashes, symptoms include fatigue, weakness, weight gain and loss of sex drive.
For most, symptoms are mild to moderate and usually last six months to two years after menopause (defined as 12 months without a period).
But about 10 to 15% experience symptoms so severe, and over such an extended period -- six to 10 years for 25% of women; more than 10 years for 10% -- that they seek medical help.
Some women don't seek help because they see menopause as a natural, normal part of aging that shouldn't be treated like a disease, she adds. All of her reading prompted Belanger to ask Shandro for bioidentical synthesized hormone therapy -- pharmaceutical products made from plants, but that are identical to the estrogen and progesterone produced by the body. BHTs have been used at the menopause clinic for 10 years.
"We don't know that they're better or safer (than the synthesized hormones that have been used for many, many years), but generally people have this sense that they might be better," Shandro says.
Proof of their efficacy could come in 2010 or 2011 when studies on BHT are complete and the findings made public. Until then, women who come to the menopause clinics are presented with all their options and given a choice.
