Estrogen Therapy

Menopause is a natural process that occurs as a woman’s menstrual periods stop and fertility ends. For many years, healthcare providers were reluctant to use hormone replacement therapy to treat symptoms. However, an updated study published in 2013 has shown hormone replacement therapy to be a safe and effective treatment for menopausal symptoms.

In 2002 a Women’s Health Initiative (WHI) study on the effects of estrogen gained media attention, with many news outlets reporting estrogen’s link to stroke and breast cancer. This caused many patients and physicians to be wary of using estrogen to treat menopausal symptoms.

A follow-up of the 2002 WHI study came out in 2013, although it was not as well publicized. The Journal of the American Medical Association followed up with the participants of the WHI study 13 years later to better study the safety and efficacy of estrogen therapy. The updated study showed that estrogen is the most effective treatment for menopausal symptoms, and it is a safe option for many women, especially women in their 40s and 50s.  

A woman enters menopause 12 months following her last menstrual period. Leading up to menopause, the body produces fewer hormones. Decreases in hormones, such as estrogen, can cause troublesome physical symptoms, such as hot flashes, vaginal dryness, and night sweats, as well as emotional symptoms. Although menopause is a natural process that requires no medical treatment, many women seek treatment when their symptoms start to negatively affect their quality of life.

As estrogen levels decrease during menopause, taking estrogen can treat symptoms. Estrogen comes in different forms. The estrogen patch is a small adhesive that you place on your skin. The patch delivers estrogen to your entire body, treating menopausal symptoms. Estrogen can also be prescribed for vaginal use. An estrogen tablet or ring placed inside the vagina acts on the body to relieve symptoms.

For women who have a uterus, it is necessary to pair estrogen therapy with a progestin, such as progesterone. This type of therapy is known as estrogen-progestin therapy or combined hormone therapy. Higher estrogen levels can cause the endometrium (the lining of the uterus) to thicken, which can lead to endometrial cancer. So if a woman has a uterus, she can safely take estrogen that is paired with a progestin. If a woman has undergone a hysterectomy, she does not need the protective effects of progestin because she already has a zero risk of developing cancer of the uterus.

As with any medication, there are potential risks and side effects associated with estrogen therapy. The Women’s Health Initiative studied women over 60 years old who were taking hormone replacement therapy. In these women, there was a higher incidence of stroke, blood clots on the leg and lungs, and breast cancer. This study showed that women over age 60 and women with a history of stroke, breast cancer, or blood clots are not candidates for hormone replacement therapy. Newer studies have shown that women who take estrogen shortly after entering menopause, which usually occurs around age 51, do not have as high a risk of developing these side effects.

Researchers believe that estrogen’s natural effects on the cardiovascular system explain why estrogen therapy is so much safer for younger women. Estrogen is believed to have a positive effect on blood vessels, keeping them flexible and reactive to changes in blood flow. When a woman’s estrogen levels decrease, this protective effect on the blood vessels diminish, putting the woman at higher risk for heart disease as she ages. Other factors that tend to increase with age, such as increased blood pressure and cholesterol, also contribute to this higher risk. So by taking estrogen right at the onset of menopause, the woman’s blood vessels are still responsive to the hormone and remain flexible for additional years. Studies have shown that taking estrogen at the onset of menopause reduces deaths caused by heart disease for women in their 50s.

Although newer studies suggest that estrogen therapy may reduce the risk of heart disease in women, estrogen is still not prescribed to prevent heart disease. Not all women who are entering menopause require estrogen therapy. It is only prescribed for women who are having troublesome menopausal symptoms and who do not have additional risk factors. Generally, your provider will prescribe you the lowest dose that is effective at treating your symptoms. This maximizes the benefits of the medication while reducing the risks.

Medicine is a field that is constantly changing. It is important to be aware of the most up-to-date information regarding your health. The newest evidence regarding estrogen therapy has shown it to be an effective and safe treatment for women experiencing menopausal symptoms in their 40s and 50s. If you suffer from menopausal symptoms, ask your healthcare provider if you would be a candidate for estrogen therapy.

Dr. Hardy practices obstetrics and gynecology at Atlantic Ob/Gyn with locations in Virginia Beach and Chesapeake. Please call 757-463-1234 or visit www.atlanticobgyn.com.

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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