Get answers to your menopause and sexual dysfunction questions.
Prepared By: Valerie A.Omicioli, M.D.
Certified Menopause Practitioner
University of Maryland School of Medicine
Baltimore, MD 21201
Appointments: 410 328-6640
DISCLAIMER: This is a question you need to discuss with your health care provider. Every individual patient has different health issues, intensity of symptoms and family health history. Whether to start or continue hormone therapy is not a "one size fits all" decision. The purpose of this web page is to help you understand all the confusing information about hormones.
If you have stopped menstruating, are in menopause and don't have any troubling symptoms, the risks of taking hormones generally outweigh any health benefits. If you are having symptoms such as hot flashes, night sweats, difficulty sleeping, vaginal dryness, painful sex, or lack of desire, you may be a candidate for hormones.
Prior to menopause, your ovary made two important hormones, estrogen and progesterone. As you age, levels of these hormones decrease, your menstrual cycles may become irregular, and intermittent hot flashes or vaginal dryness may occur. This transition time is called perimenopause.
Menopause occurs with your final menstrual period and is confirmed by 12 months in a row without a period. The average age at which menopause occurs is 51-52, but menopause can occur any time between ages 45-55. About 2-3 women out of 100 will be older or younger than this age range when they go through menopause. Postmenopause is all the years after your final menstrual period.
Hormone therapy relieves menopausal symptoms such as hot flashes, night sweats, interrupted sleep, vaginal dryness, painful intercourse and reduced sex drive. It can also reduce the risk of osteoporosis and increase bone density. If estrogen is started within a few years of menopause, it can reduce the risk of heart disease and colorectal cancer.
Most of the studies conducted on risks and benefits of hormone therapy used higher doses than are commonly prescribed today. Studies show that estrogen plus progestin therapy increases the risk of blood clots (venous thromboembolism), stroke, and breast cancer. If estrogen plus progestin is started 10 or more years after menopause, it increases the risk of heart disease.
Since 2002, more than 13,000 articles have been published in the consumer literature. Patients have been flooded with a sea of confusing information. Surveys have shown that health care professionals are the most important source of information for women considering hormone therapy. The scientific literature is changing as more studies are conducted. Research is ongoing looking at different doses of estrogen, different combinations of hormones, different ways to administer estrogen, and alternatives to estrogen therapy.
The Women's Health Initiative, or WHI, was a major study funded by the U.S. government involving 160,000 women. Because this was such a large study, the results received a lot of publicity. The number of women who had either a positive or negative effect was so small, that the study cannot be used to determine what would happen to an individual woman. The average age of women in this study was 63, about 10 years post menopause, much older than women who usually start hormones to relieve symptoms.
The study was not designed to measure the effects of hormones on menopause symptoms, since many of the women in the study were not having symptoms. It was designed to look at other risks and benefits of hormones. The best type of scientific study compares women who take a medication to other women who don't take the medication, but receive an identical appearing dummy pill (placebo). The person in the study doesn't know if they are getting the medication or the dummy pill.
In one section of the WHI study, approximately 16,000 postmenopausal women were prescribed estrogen with progestin or placebo (identical looking dummy pill). The second section of the WHI study involved women who had had a hysterectomy and included 10,739 women who took estrogen only or placebo. What did they find?
The results of the WHI showed small increases in the chance of developing breast cancer, heart disease, blood clots or stroke in women who take estrogen plus progestin, and small decreases in the chances of developing hip or spine fractures, and colorectal cancer.
In women taking estrogen alone, it found small increases in the risk of stroke, blood clot, and colorectal cancer and small decreases in the risk of heart disease, breast cancer, and vertebral or hip fractures. In both of these studies, the chance for an individual woman having any of the risks or benefits was less than 0.2 percent per year.
Any of these risks may be increased or decreased by your health status, co-existing medical conditions and family history. The decision whether to start or continue hormone therapy is complex and should also consider the severity of your symptoms and the impact of these symptoms on your quality of life. It is important to discuss the issue fully with your health care provider.