There was a report from the WHI that focused on breast cancer cases and risk of dying associated with the use of common hormones used in menopause….Prempro (combined conjugated equine estrogens and medroxyprogesterone acetate).   The study consisted of an average treatment time of 5.6 years and followed patients for an average of 11 years.

The new data relates to the risk of dying from breast cancer.  The study showed an extra 1 to 2 deaths from breast cancer per 10,000 women per year.  Specifically, for every 10,000 women in the study who were randomized to placebo, there were 1.3 deaths from breast cancer per year. For every 10,000 women randomized to combined hormone therapy, there were 2.6 deaths from breast cancer per year.  

Importantly, these results apply to the use of the combination of estrogen and progestin and not to estrogen alone. Therefore, for women who have had a hysterectomy and taking only estrogen…these results do not apply.  Similarly, the study did not study all types of hormone therapy.  Neither estradiol products or progesterone products were studied….therefore, no conclusion can be drawn about these products.  Read more…

The perimenopause is a confusing time for women. The perimenopause is a distinct transition between the reproductive years and cessation of menses. This article will hopefully help to explain and offer treatment options for this often frustrating transition. The World Health Organization defines the onset of the perimenopause as the beginning of menstrual cycle changes. Early perimenopause changes include the first break in regular cycling of menses. Late perimenopause is classified after missing 3 to 11 months of menses, while menopause is reached after 12 months of no menstrual flow. Women usually notice the onset of perimenopause symptoms during their 40’s and irregularities usually persist for approximately 5 years.

The range of perimenopause symptom duration may be quite variable, from 2 to 8 years, or even longer. In general, the later in life that perimenopause symptoms begin, the shorter the transition to menopause. The hormonal changes taking place probably represent the major cause of symptoms experienced. These changes can produce many symptoms that are traditionally thought to only occur after menopause.

Contrary to popular belief, the perimenopause may be associated with elevations of estrogen levels. However, these elevations are generally followed by abrupt falls in estrogen levels. The constantly changing hormone levels of the perimenopause can precipitate significant hot flashes and night sweats. The ‘peaks and valleys’ of estrogen production during the hormonal ‘roller coaster’ invariably contribute to these symptoms. Other medical conditions commonly seen during the perimenopause years that can mimic these symptoms are thyroid irregularities and diabetes.

Read more…

Hormone therapy is prescribed for troublesome symptoms during menopause.  While very effective in treating symptoms such as hot flashes, night sweats and mood changes, its use has declined due to safety concerns.  These safety concerns became very well publicized after the 2002 report from the Women’s Health Initiative study. Click here for more information.

Currently, the use of hormone therapy is still considered the gold standard for treating moderate to severe menopause symptoms.  Due to safety concerns, use is generally limited to the lowest effective dose for the shortest time frame.  However, women still have concerns about the potential risks associated with hormone therapy use.  Fortunately, there is new research showing a potential benefit to alternative ways that hormone therapy is administered. 

Hormone therapy is commonly administered in an oral tablet form.  However, hormones can also be delivered effectively via the skin in a transdermal patch form.  Due to the manner in which the hormone is metabolized once absorbed, practitioners have wondered if the patch is a safer way to deliver hormones.  Click here for more information. 

Good News for Women

Fortunately, two recent studies have found the transdermal patch to be a potentially safer way to administer menopause hormones.  Most recently, Dr. Suissa and colleagues from McGill University in Montreal reported that the use of a low dose estrogen patch does not seem to increase the risk of stroke(1).  In March, the same group reported that the patch was not associated with an increased risk of blood clots in postmenopausal women.  Read more…

The American Heart Association has updated its recommendation regarding hormone replacement therapy (HRT). Their current recommendation states that physicians should not base the decision to use HRT based upon heart disease prevention. This recommendation is the result of a number of relatively recent studies refuting earlier data about the protective effects of HRT on the cardiovascular system.

Most gynecologists prescribe HRT for the treatment of menopause symptoms, such as hot flashes, vaginal dryness, and sleep disturbances. However, from 1995 until 1999 the American Heart Association had recommended that physicians consider estrogen for all postmenopausal women with cardiovascular disease. Read more…