If you’re unsure about the benefits and risks of hormone therapy, you’re not alone — even healthcare providers are exasperated about the mixed messages women receive.
So to be clear, hormone therapy remains the most effective treatment for hot flashes and night sweats (also called vasomotor symptoms, or VMS), according to the 2022 statement of the North American Medical Society (NAMS). For most women under 60, the benefits of therapy for bothersome symptoms and prevention of bone loss outweigh the risks, per the society.
Multiple updates from the U.S. Preventive Services Task Force (USPSTF), however, recommend against the use of hormone therapy for the prevention of heart disease, diabetes, and certain types of cancer. These updates have exasperated menopause experts and left many women unsure about the safety of hormone therapy.
We asked Stephanie Faubion, MD, director of the Center for Women’s Health at Mayo Clinic and medical director of the North American Menopause Society (NAMS), to dig deeper into the issue of hormone therapy and to put to bed the lingering confusion.
The conversation has been edited for clarity and length.
Everyday Health: The USPSTF issued recommendations against hormone therapy for chronic disease prevention. NAMS agrees it should not be used for that purpose. Why are the recommendations a problem?
Stephanie Faubion: Why did they feel a need to come out for a fifth time and say this when no medical society recommends that they be used for that? Our NAMS position statement on hormone therapy certainly does not.
The task force statement dissuades people from treating symptoms related to menopause. That’s the problem — people conflate the two.
Also, the task force has not researched or made any statements about the use of this therapy for vasomotor symptoms of menopause [such as hot flashes], which of course we’d like to see since the evidence is strong.
EH: Tell me about that evidence?
SF: Multiple studies have shown that it [hormone therapy] is effective in treating hot flashes.
Even in the Women’s Health Initiative study [the popular, large-scale study that first reported the unwarranted risks when using hormone therapy for preventing chronic conditions such heart disease], which was not designed to look at vasomotor symptoms, when you look at the women in that study who are in their fifties — the population we are most likely to treat for vasomotor symptoms — the benefits tend to outweigh the risk for those women.
EH: As a JAMA editorial notes, when women unnecessarily worry about taking hormone therapy, they instead turn to nonhormonal treatments like antidepressants, anticonvulsants, and dietary supplements. But there isn’t data on the long-term risks of these treatments, is there?
SF: That’s exactly right. We have no idea what the long-term effects are of using an antidepressant like an SSRI [selective serotonin reuptake inhibitor] for symptom management, but I can guarantee you there are some, because no medication is without adverse effects. Also, other drugs used, such as gabapentin [used to prevent seizures and relieve nerve pain], can cause weight gain, sometimes substantial weight gain.
There are even reports of women using cannabis, and there’s no data on safety or efficacy there. But for some reason women feel more comfortable using things like that than they do hormone therapy because of publications such as [the recommendations from the USPSTF] that make it all very confusing.
There’s a lot of false advertising for supplements and other products that claim there are benefits when they really haven’t been proven, and that they’re safer than FDA-approved hormones, and that’s simply not true.
EH: So what is NAMS’s position on hormone therapy?
SF: There are three indications for use of menopausal hormone therapy. One, for vasomotor symptoms — that includes hot flashes and night sweats; two, for genitourinary syndrome of menopause, which may include vaginal dryness, painful urination, or painful sex; third, to help prevent bone loss and reduce fracture risk.
Each woman should work with her doctor to find the most effective formulation, dose, and route of administration. For example, there’s some observational evidence that would suggest maybe a transdermal route of administration (for example, a patch or a cream) is safer than an oral route.
All estrogens are not the same; all progestogens are not the same. We give them through different routes of delivery, like oral or a patch or a vaginal ring.
And we give them in different doses. So now more than ever, we can start to individualize therapy for women based on their symptoms, past medical history, and family history.
And all this needs to be assessed on a regular basis. I have my patients return once a year, or sooner if any symptoms change or if anything’s new about their personal or family history. We don’t just put somebody on hormone therapy and say, “You’re on it forever.”
We also don’t recommend you stop taking them in three or five years or at a certain age. It’s really based on a woman’s ongoing need for hormone therapy, and what’s new with her health. Some women elect to continue with hormone therapy longer, perhaps because their symptoms persist and nothing else is adequate to manage them.
EH: Let’s talk about hot flashes and night sweats. They can be a lot more debilitating than people realize, right?
SF: Women are missing work, changing jobs, turning down opportunities for advancement at work because of these symptoms. These are not trivial. They’re impacting women’s lives, their relationships, and their ability to function.
Symptoms are often long in duration — the average length of time is seven to nine years, and 10 percent of women will have symptoms even longer. When women have moderate to severe symptoms for this long, waiting it out probably isn’t a great option.
EH: What’s your overall message to women about hormone therapy for hot flashes?
SF: If a woman is under 60 and within 10 years of experiencing menopause, the benefits of hormone therapy tend to outweigh the risks.
The fact is that these USPSTF warnings that come out sound so dire they make women believe that the benefits do not outweigh the risks for management of menopausal symptoms when they do.
from Ketone Blog https://ketone2013.com/hormone-therapy-safe-for-hot-flashes-not-prevention/
via Keto News
No comments:
Post a Comment