Menopausal hormone therapy was once the most commonly prescribed treatment in the United States. In the late 1990s, some 15 million women a year were receiving a prescription for it. But in 2002, a single study, its design imperfect, found links between hormone therapy and elevated health risks for women of all ages. Panic set in; in one year, the number of prescriptions plummeted.Hormone therapy carries risks, to be sure, as do many medications that people take to relieve serious discomfort, but dozens of studies since 2002 have provided reassurance that for healthy women under 60 whose hot flashes are troubling them, the benefits of taking hormones outweigh the risks. The treatment’s reputation, however, has never fully recovered, and the consequences have been wide-reaching.About 85 percent of women experience menopausal symptoms. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes that, in general, menopausal women have been underserved — an oversight that she considers one of the great blind spots of medicine.“It suggests that we have a high cultural tolerance for women’s suffering,” Thurston said. “It’s not regarded as important.”To hear more stories from publications like The New York Times, download Audm for iPhone or Android.
The author discusses her experience of researching and writing an article about menopausal hormone therapy, its real risks and benefits, and why it has been wrongly vilified in the past. She also shares her personal insights on how discussions about menopause are becoming more common among women in their early 50s.
This article discusses the historical significance of the book Feminine Forever, which marked the start of a complicated relationship between women and hormone therapy. It also highlights the benefits of hormone therapy in treating menopausal symptoms, including urinary tract infections and pain during sex.
The Women's Health Initiative, started in 1991 by Bernadine Healy, was the largest randomized clinical trial in history to involve only women, studying health outcomes for 160,000 postmenopausal women, and found that hormone therapy carried a small but statistically significant increased risk of cardiac events, strokes, and clots, as well as an increased risk of breast cancer.
According to Manson's analyses, women who start taking hormones after age 60 have a small elevated risk of coronary heart disease, and a significant elevated risk if they start after age 70. Women who go through early menopause are recommended to take hormone therapy to avoid osteoporosis. The highest risk for hormone use are women who have already had heart attack, breast cancer, stroke, or blood clot, or women with a cluster of significant health problems.
Hormone therapy may be worth facing down whatever incremental risks it entails for women who are steadily losing hair, have joint pain, realize that their very smell has changed, or are depressed or exhausted, even after the age of 60. However, hormone therapy is not a fountain of youth and should not be used for anti-aging or general prevention purposes.
Hot flashes experienced by women may be more than just a short inconvenience as research suggests that for some the symptoms can last for up to 14 years, with a potential link to mild cognitive changes during menopause.
The author reflects on the lack of understanding and research when it comes to menopausal symptoms, causing women to apologize for complaining and not receive proper treatment.