MENOPAUSAL HORMONE THERAPY:

 

Helping women navigate the menopause transition with confidence

 

THE FACTS ABOUT MENOPAUSE HORMONE THERAPY (MHT)

  • Estrogen is the most effective treatment for all menopausal symptoms, including hot flashes, night sweats, insomnia, palpitations, joint and muscle aches, headaches, bladder disorders, sexual discomfort and depression.
  • Estrogen alleviates vaginal dryness. It also reduces dryness of the nose, mouth, eyes and scalp.
  • Women taking estrogen live on average several years longer than those not taking it.
  • The same number of women die annually following osteoporotic hip fracture as die of breast cancer. MHT can cut the risk of hip fracture in half.
  • Women taking estrogen have a 35% lower incidence of Alzheimer’s disease. Estrogen therapy reduces cognitive decline. This exceeds the benefit from treatment with Alzheimer’s medications.
  • Estrogen does not increase the risk of breast cancer. Even breast cancer survivors may safely take MHT under a doctor’s supervision, and it does not increase their risk of recurrence.
  • The annual risk of death due to heart disease is seven times higher than dying of breast cancer.  Heart disease, not cancer, is the leading cause of death among breast cancer survivors, and estrogen can decrease that risk by 30-50 percent.
  • Estrogen reduces the risk of colon cancer. One study revealed that MHT was associated with a 63% reduction in the risk of colon cancer.
  • There is no evidence to support the previous advice to take MHT at the lowest dose for shortest period of time.
  • WHI researchers, with all their skepticism about MHT, reported in 2004 that woman using MHT had a 21% lower risk of diabetes, likely due to increase in activity and lower weight.
  • The Menopause Society issued a position statement In 2017 that “hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 and can be considered for continuation beyond age 65 years for persistent vasomotor symptoms, quality of life issues, or prevention of osteoporosis after evaluation and counseling for benefits and risks….. This is endorsed by 31 international menopause and women’s health organizations.
  • It is important to underscore that certain benefits of MHT – notably the positive effect on bone mass and prevention of osteoporosis disappear when women stop taking it.
  • No increased risk of breast cancer has been reported in women using (natural) micronized progesterone.

TESTOSTERONE THERAPY FOR POST-MENOPAUSAL WOMEN

  • Testosterone is an important hormone in women’s wellbeing, but treatment with testosterone for women’s hypoactive sexual desire disorder (HSDD) has been controversial.
  • Multiple publications support the “off label use” of testosterone therapy for HSDD in postmenopausal women.
  • The use of testosterone therapy in women may improve sexual function, general well-being, mood, cognition and musculoskeletal health.
  • Testosterone therapy that increases serum concentrations to the upper limit or slightly above the limit of normal for postmenopausal women has been shown to improve female sexual function in selected populations of postmenopausal women.
  • Testosterone dose levels in treated adult males are approximately 10 to 15 times higher than levels in females. Thus, for postmenopausal patients, the dose of testosterone should be 10 percent or less than the standard male dose.
  • We do not recommend doses of testosterone treatment that would increase a woman’s level to the low male range due to the potential risk of side effects, even though it may significantly increase sexual desire in female.
  • There is no FDA approved testosterone product available for women in the United States. However, off label use of FDA approved products for men is supported in the literature.
  • Candidates for therapy must have no contraindications to taking androgens or estrogens, as androgens are converted to estrogens in the body.
  • A commonly used preparation is testosterone transdermal topical gel applied daily to the skin of calf in appropriate doses. The dose may be started lower and adjusted by blood test periodically under the supervision of the prescriber.
  • Using an inappropriate or excessive dose of testosterone must be avoided.
  • Although testosterone therapy should be considered only for post-menopausal women, limited data also support the use in late reproductive age premenopausal women in selected cases when there is no possibility of pregnancy in the future.
  • Testosterone therapy should not be prescribed for premenopausal patients for hypoactive sexual desire disorder when there is the possibility of pregnancy in the future.
  • We do not recommend compounded testosterone products.

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