Are you between the ages of 35 and 49 years of age and have gone through either early natural menopause or a surgical one? Are you having bothersome symptoms like hot flashes, night sweats, insomnia, headaches, and memory loss, and are afraid to try hormone replacement therapy? Good news! There is new research endorsing hormone replacement among women going through menopause before age 50.
Reason for Reluctance
Many women remain reluctant to use hormone therapy (HT) due in large part to the halted government-sponsored Women’s Health Initiative (WHI) Program in 2002. This study focused on a drug Prempro® (which contains synthetic estrogen and synthetic progesterone or progestin). The study was conducted on 16,000 women between the ages of 50 to 79 who had not had a hysterectomy. Participants were given either Prempro® or a placebo. The study ended three years earlier than initially planned because researchers found that there was an increased risk of breast cancer in some of the women who were participating in the study and taking the Prempro®. An analysis of the study also revealed that heart attack risk began increasing in the progestin group early in the study.
The results led to widespread uncertainty and fear among patients, and the use of estrogen and progestin and even estrogen alone has declined sharply since the WHI results were published.
Risk Factors with Early Menopause
There are clinical studies showing how early menopause (entering menopause from ages 40 to 44) can increase a woman’s risk for many medical conditions, such as coronary heart disease, diabetes, and cognitive function decline. Researchers found that women who entered menopause at age 40 years or younger had worse fluency and visual memory in later life. In addition, premature menopause was associated with a 30% increased risk for decline in psychomotor speed and global cognitive function over seven years. Furthermore, several studies have linked a lower bone mineral density in women with early menopause and an increased risk for fracture later in life.
Estrogen is Essential
Dr. JoAnn Manson, an endocrinologist at Brigham and Women’s Hospital, and professor of medicine at Harvard Medical School, noted that “Most of the adverse health effects after early menopause can be traced to the loss of ovarian estrogen.” She further stated, “An early decline in ovarian estrogen is associated with an increased risk for heart disease, osteoporosis and all-cause mortality, and this is because estrogen does have a role. The premature loss of estrogen can increase the risk for those conditions as demonstrated in a number of observational studies.”
Also, many women going through early menopause often experience a range of distressing symptoms like hot flashes, difficulty sleeping, impaired concentration, mood swings and vaginal dryness. These symptoms can vary in severity depending on whether it’s an early natural menopause or a surgical one. These symptoms could be abrupt and severe enough to be debilitating.
Decline in HT Use Resulted in Health Events
Studies have suggested that the confusion surrounding HT may have led to adverse health events and death. After the WHI study, Darrel and colleagues analyzed the effects of estrogen avoidance on mortality rates of women aged 50 to 59 years who had undergone a hysterectomy. The researchers related excess mortality among women assigned to placebo in the WHI to the population of comparable women in the United States, incorporating the decline of estrogen use between 2002 and 2011.
“Over a 10-year span, starting in 2002, a minimum of 18,601 and as many as 91,610 postmenopausal women died prematurely because of the avoidance of estrogen therapy,” Sarrel and colleagues wrote. “[Estrogen therapy] in younger, postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall.”
Doctor Erica Wang, a reproductive endocrinologist and infertility specialist in the department of obstetrics and gynecology at Cedars-Sinai stated, “Young women’s bodies expect to have estrogen. There’s a lot of debate over hormone replacement, but that does not apply to early or premature menopause. Estrogen is important for cardiovascular health, osteoporosis prevention and overall well-being.”
Patients considering HT often express fears of increased breast cancer risk, citing the WHI study results on estrogen-progestin therapy. However, this study was a study on a synthetic drug and not hormone replacement. Women now have many options, including bioidentical hormone replacement where dosing is individualized based on need versus a one-size-fits-all therapy. Dr. Wang further stated in response to fears of HT, “Everyone is scared of breast cancer… but we also have to educate women on the benefits of estrogen on other aspects of their health, such as bone protection.”
What the Experts Say
Dr. Manson agrees that clinicians must stress the benefits versus the risks in the setting of early menopause. She has also stated, “Most importantly, women with premature menopause should understand that the findings of the WHI, in terms of the balance of benefits and risk of HT, do not apply to their situation. The WHI findings apply to a postmenopausal group of women with a mean age of 63 [years] at the time they were randomized to HT. So for women who have early surgical menopause and do not have contraindications to estrogen therapy, the benefits are likely to outweigh the risks.”
“In the premenopausal setting, estrogen is extremely important for maintenance of optimal health, and it’s important to nearly every organ system,” Manson said. “When we’re talking about natural menopause at a more typical age, there may be controversy about HT for purposes beyond symptom management, because estrogen plus progestin therapy is associated with a complex pattern of benefits and risks. But in the premature or early menopausal state, it’s more straightforward that the benefits of estrogen therapy would likely outweigh the risks in women without contraindications.”
Conclusion
Clearly research has shown the health risks associated with women and early menopause whether it is natural or surgical. Due to the confusion surrounding the 2002 WHI study, women have feared the use of hormone replacement. However, clinical data is now showing how the fear of hormone use, especially in women undergoing early menopause, has created a detriment to their overall health. If you are having symptoms of menopause and are under the age of 50, get tested to see what your baseline hormone levels are to see if hormone therapy is right for you.
Testing for hormones is available at TLC Medical Centre Pharmacy. Compounding for bio-identical hormone replacement is available in our compounding lab Custom Prescription Compounders, LLC. We work closely with you and your doctor to customize hormone treatment that will fit you individually for optimum balance and health. Call 648-7800 for your free 15-minute consultation to get started.
