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Take the 'Bite' Out of HRT

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Menopause is the great equalizer. It doesn't care what your occupation is, which political party you identify with, what your religious background is, what the color of your skin is, or whether you are in the 1 percent or 99 percent economically. Everyone in it is facing the same fundamental challenging symptoms and health issues regardless of social and financial standing, where they live, or any aspect of where they were raised. Got a vagina or know someone who does? Welcome aboard! We are in the same big boat together, and I want to share my story with you.

My story began in my 40s. I couldn't sleep, my mind would freeze mid-sentence, and my emotions were out of control -- I was a total bitchface! As if that wasn't enough, in the middle of my business meetings I would stand up to find that my entire outfit was suddenly drenched. My libido was crashing and for some reason my shmirshky (vagina) had taken a trip to the Sahara Desert. It was parched and dry. On a scale of 1-10, I was functioning at a 2, which left me scared, mortified and depressed.

After many sleepless nights of researching my symptoms and reaching out to the sisterhood, I figured out I was in perimenopause -- a word I had never heard before. Perimenopause is the 6- to 10-year symptom-laden time before you reach menopause. You have reached menopause when you have not menstruated for a full year (the average age of menopause is 51). Back it all up and you find that perimenopause generally begins between the ages of 38 and 48 years young! Some women, like supermodel Karolina Kurkova, find they have a thyroid condition that can cause them to go into early menopause at the age of 24! Early menopause can happen to anyone.

Why had no one ever told me about this?

Are you experiencing any of these symptoms? Has your lover, mother, aunt, sister, friend or coworker encountered them? Did your mom ever sit you down and tell you about what happens when the period starts to pack up and leave?

Three letters changed my life: HRT. No, it is not an abbreviation for heart, although I do love my heart. HRT (hormone replacement therapy), also know as HT (hormone therapy) comes in many forms and styles, but more than likely you will not read much about this in the fashion magazines.

In the 1990s, researchers began a large U.S.-sponsored study focused on women taking Prempro (a combination of non-bioidentical estrogen/progestin) as well as a study on women taking just Premarin (non-bioidentical estrogen only). The Prempro study was stopped in 2002 as it was linked to higher risks for heart attacks and breast cancer. As you might expect, the major news outlets made a very big deal of this, and news headlines were broadcast everywhere warning of the horrible side effects. These media flashes caused most women to flush their synthetic hormones down the toilet! Then in 2004, the Premarin study was halted after researchers detected stroke and blood clot risks in that group. The same thing occurred at that point -- headlines and more headlines!

Most women are too busy to read the actual studies, or too overwhelmed by the nature of their content. Instead, they respond to media soundbites and often mistakenly let these small bits of information determine the course of their health care. Here are a few from back in 2002:

Telegraph -- July 10, 2002 -- "HRT raises cancer and stroke risks"

BBC News -- July 10, 2002 -- "The UK Government orders an investigation into HRT after a US study shows it may cause cancer, heart disease, and stroke"

LA Times -- July 11, 2002 -- "Doctors report post-menopausal women are 'scared' as they face choices after study's halt"

NIH -- July 16, 2002 -- Increased Risk of Ovarian Cancer is Linked to Estrogen Replacement Therapy

For about 10 years now, these headlines and the "common knowledge" regarding the use of HRT scared untold numbers of women away from any form of HRT. Of course, in our lawsuit-crazy society, many doctors ran away from prescribing HRT even faster than their patients.

Now in 2012, revised research and interpretations of that research has finally come to light. We find ourselves with a whole new set of headlines and media flashes very different from those 10 years ago.

Here are some of the latest soundbites:

Bloomberg -- March 6, 2012 -- "Estrogen-only therapy may protect against breast cancer"

LA Times -- March 7, 2012 -- "Estrogen taken alone is linked to lower breast cancer risk"

PhysOrg -- Feb. 27, 2012 -- "North American Menopause Society (NAMS) reassures many women"

Endocrine Today -- March 5, 2012 -- "HT safe during menopause when tailored to individual patients"

Right about now, you may feel like you've had your fill of soundbites and are so confused and frustrated that you want to "bite" someone!

Many of the principal investigators of the WHI now agree that they did not do such a great job reporting the outcomes of the study in 2002. Shockingly, there are many doctors out there that are not aware of the new studies, their findings and revised guidelines. Dr. Henry Burger, a consultant and endocrinologist at the Melbourne clinic, Jean Hailes for Women's Health, said few doctors other than specialists were aware of newer research indicating HRT was safer than previously thought: "The regulatory authorities act as if that was never published.'' Professor Burger said menopause was not trivial: ''At least 10 per cent of women will have symptoms for 10 years or more and they're very disabling. It's a huge threat to women's quality of life. One of the major problems is interrupted sleep, which makes people tired, irritable and depressed. People with bad flushes get them every half an hour.''

Leave the soundbites behind, save the bites for dessert and arm yourself with the latest accurate information. Together with your perimenopause and menopause specialist, evaluate your own risks and benefits and get the help you need and deserve.

A lot has been discovered over the past 10 years. Here is a CliffsNotes version:

  1. HRT (HT) is the most effective treatment available for some menopausal symptoms. (Science Codex)
  2. The risks in healthy women below age 59 seem to be low. (MedPage)
  3. It is best to start HRT before age 60, as the benefits are greatest and the risks are minimized. In particular, one should not start oral HRT after age 60. (Women's Health Concern)
  4. Both ET delivered through the skin (transdermal) and low-dose oral ET have been associated with lower risks of blood clots and stroke than standard doses of oral estrogen. (Science Codex)
  5. ET (estrogen therapy) is the most effective treatment for symptoms of vulvar and vaginal atrophy. Low estrogen can cause vaginal dryness, discomfort in intercourse and an increase in urinary tract infections. Some women find help using low-dose local vaginal ET for vaginal dryness or discomfort with intercourse. Many doctors use estriol (some doctors tell me that they add a touch of testosterone). (Endocrine Today)
  6. To protect the lining of your uterus, it is suggested to use progesterone therapy along with your estrogen (EPT). (Healthy Women)
  7. Women in premature or early menopause can use HRT. (Science Codex)
  8. HRT is safe for the treatment of menopause symptoms and to prevent osteoporosis. (Endocrine Today)
  9. There is a difference between bioidentical hormones and non-bioidentical hormones (generally referred to as synthetic). Bioidentical hormones are identical to what your body naturally produces. (Dr. Josh Trutt, "Understanding Hormone Replacement Therapy," Shmirshky)
  10. Women taking synthetic (non-bioidentical) estrogen alone are shown to be 23 percent less likely to develop breast cancer compared with those taking a placebo during an overall follow-up period of about 12 years. Participants "in the estrogen group who did develop breast cancer were 63 percent less likely to die from the disease than those in the placebo group." (Bloomberg)
  11. Early breast cancer survivors who have been treated successfully may consider using hormone replacement therapy. It may decrease the risk of heart disease, colon cancer, Alzheimer's disease and osteoporosis, making life more enjoyable and possibly longer. (American Journal of Obstetrics and Gynecology)
  12. HRT is our single most powerful weapon against Alzheimer's disease: Women who start estrogen replacement within five years of menopause have HALF the risk of Alzheimer's compared to women who don't. (JAMA)
  13. Estrogen may prevent early postmenopausal bone loss and augments bone mass in late postmenopause. (NIH)
  14. Women who start HRT before age 60 decreased their overall mortality by 35 percent. (Endocrine Society)
  15. Men, listen up! Testosterone replacement appears not to cause prostate cancer. (Harvard)

(To read more, here is the full 2012 Position Statement from NAMS.)

Hopefully, one day, talking about perimenopause and menopause will be in style and regularly addressed in all women's magazines.

I am always here for you at www.shmirshky.com if you have any questions or simply need a virtual hug! Reaching out is IN! Suffering in silence is OUT!

Ellen Dolgen is the author of Shmirshky: The Pursuit of Hormone Happiness -- a cut-to-the-chase guidebook on perimenopause and menopause.