Menopause Hormone Therapy (MHT)

Women have their final menstrual period between the ages of 45 to 55 years with a mean age of 51 years. Menopause is associated with a markedly decreased estrogen production by the ovaries resulting in low estradiol concentrations and hot flashes in the majority of women. Estrogen is an effective treatment for relief of hot flashes and other menopausal symptoms. Approximately 50 percent of postmenopausal women eventually develop symptoms of vulvovaginal atrophy, including vaginal dryness and painful sexual intercourse, collectively called: genitourinary syndrome of menopause.

Menopause Hormone Therapy (MHT), previously called Hormone Replacement Therapy (HRT) was celebrated as a medically miraculous treatment for most of the past century and up to 2002. Millions of women using MHT obtained relief from the symptoms of menopause. MHT, which is estrogen with or without progesterone (depending on presence or absence of uterus), improved hot flashes, brain fog, mood, depression, sleep and general well-being. Also, there was less incidence of Alzheimer’s, osteoporosis and bone fracture among women using MHT and women had a 50% lower risk of dying of heart attack if they started MHT within 10 years of menopause. Millions of women have felt better and lived longer using MHT.

At a NIH press conference in 2002, researchers announced a surprising discovery that HRT causes breast cancer based on a study of 16,608 women. They concluded that “these findings are the first confirmation from the rigorous clinical trial that taking estrogen plus progestin increases the risk of breast cancer”. The NIH investigators outlined that adding the HRT resulted in “a 26% higher incidence of breast cancer”. They claimed the study was stopped because of the concerning finding, but they did not release supporting data. This shocking announcement vibrated through the entire medical community internationally and created anxiety for women and doctors. Unfortunately, due to this misleading statement, the entire practice of menopause management, one of the most significant segments of a woman’s life, was downgraded and HRT was suddenly considered a carcinogen. The prescribing of NHT was mostly abandoned. Ultimately, the actual publication of the article in Journal of American Meical Association (JAMA) did not support a statistically significant difference in the rate of breast cancer in women taking HRT compared to those of placebo.

In 2002, Time Magazine featured a woman on its cover with a frightening headline “The truth about hormones: Hormone-replacement therapy is riskier than advertised. What’s a woman to do?”.  Soon after that, Doctors stopped prescribing HRT.  Media had a tremendous role in jumping ahead and creating long-lasting concern and anxiety. The effect of the authors’ misinterpretation of the data continued in the mind of women, physicians, medical educators, nurses and other providers. Unfortunately, the message that HRT causing breast cancer was set in stone for a long time and amazingly, many doctors still believe that HRT should not be prescribed because of that publication. The Woman’s Health Initiative (WHI), one of the most expensive NIH studies at a cost of approximately one billion dollars to taxpayers, created wrong guidance for women’s health.

Unfortunately, the generation of millions of women were deprived of this life changing treatment. Later information came to light as follow-up studies found the participants that took estrogen alone had a lower risk of breast cancer by 23%, and lower risk of breast cancer death by 40%. That benefit diminished over time after women discontinued their HRT.  According to a study by researchers from Santa Clara medical center (Stanford and the University of California San Francisco), analyzing 30 trials with a total of 26,708 women participants, HRT was not associated with an increase in cancer mortality, conversely, women who took HRT lived longer. In the subset of 17 trials in which women began HRT before age 60, HRT was associated with a reduction in total mortality of 39%.

The immediate Improvement following initiation of HRT and the relief of the symptoms of menopause has been impressive and one of the most rewarding medical interventions. The power of HRT to eliminate or improve symptoms of menopause has never been controversial.

HRT also reduces the risk of a host of medical problems including:

• Reduces cognitive decline. Women taking estrogen have a 35% lower incidence of Alzheimer’s. This exceeds the benefit resulting from treatment with Alzheimer’s medications.
• Reduces the likelihood of bone fracture from a fall or car accident. It reduces the risk of fracture by 50 to 60%. Bone fractures kill women. The number of women who die each year from hip fracture is about 40,000, roughly equal to the number of women who die from breast cancer.
• Prevents heart attack. Researchers from the University of California in San Diego and Johns Hopkins reported that most studies of HRT show around a 50% reduction in risk of coronary events.
• Reduces the risk of colon cancer. A study of more than 2,600 Israeli women reported in the Journal Clinical Oncology revealed that MHT was associated with a 63% reduction in the risk of colon cancer.
•  Alleviates vaginal dryness. MHT also reduces dryness of the nose, mouth, eyes and scalp
• 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