As much as people talk about certain topics, until you have to live them you don’t know how you’ll react. This maxim applies to many aspects of life… Especially when it comes to health. Because it’s good to know that there exists a medical treatment safe, effective and widely studied to alleviate certain symptoms in menopause. But at the moment when the gynecologist, family doctor, or endocrinologist is about to prescribe that solution, doubts arise. “Hormone therapy? No, it’s better I stay as I am, it’s just that I don’t see clearly about hormone treatment…”
The Dr. Antonio Muñoz, head of the Gynecology Service at HLA Hospital Universitario Inmaculada (Granada), part of the ASISA group, confirms that, indeed, this treatment continues to raise suspicions. “After many years of bad press, patients still arrive with many doubts,” he corroborates. In short, despite the passage of time, its bad reputation still weighs on it. And it’s not easy to forget those headlines that, back around 2002, claimed that hormone therapy in menopause would raise, among other things, the risk of breast cancer. “In fact, to this day that remains the main doubt with which they come to consultation,” adds Dr. Muñoz.
With the FDA’s Blessings
In the face of these concerns, there is the certainty that, more than 20 years later, we know that hormone therapy is safe. In addition to all the scientific evidence accumulated during this time, a lot of what has mattered has been the fact that the FDA removed the shadow of suspicion.
A few months ago, an advisory committee of the US health regulator recommended removing the warning box about elevated risk from many products for menopausal hormone therapy. “Indeed, for some time now it has been recovered as part of the available therapeutic arsenal. Especially after the FDA’s recent indication,” comments the ASISA expert.
Benefits vs. Risks
It isn’t the only thing that has brought hormones back into a central place in gynecological consultation. “It has been known for years that the cardiovascular, skeletal and quality-of-life benefits outweigh the risks, in addition to improving other milder but very uncomfortable symptoms, such as hot flashes and vaginal and skin dryness,” notes the doctor.
Moreover, as Dr. Natalia Gennaro stated in the latest edition of ASISA WeLife Menopause, “this therapy, applied in the first ten years of menopause, reduces the risk of breast cancer.”
But Talking About Hormones Still Worries
Although perhaps it is the most sensational, the fear of suffering breast cancer is not the only worry faced by those considering therapy. “There is also, especially at the beginning, a certain rejection due to fear of its side effects or, in some cases, fear that symptoms such as migraines, varicose veins or fluid retention may worsen,” notes the gynecologist.
While not denying that the treatment can have side effects, the therapy offers undeniable benefits to patients. Although it is advisable to analyze thoroughly and in a personalized way each patient to prescribe the appropriate treatment, or to rule it out.
When Therapy Is Not Advisable
“There are cases in which prescribing it is not advisable. The absolute contraindications are mainly: history of hormone-dependent cancer (breast or endometrium), deep vein thrombosis, pulmonary embolism, vaginal bleeding of unknown origin and severe liver diseases,” explains the doctor.
It should not be started in women over 60, and after that age the follow-up must be very precise.
Therefore, in all cases, periodic medical supervision is fundamental, as well as, of course, a 100% individualized prescription. “First of all, I consider it essential to carry out a proper initial examination and, at minimum, a transvaginal ultrasound, breast examination with mammography and ultrasound, and tests of liver function and coagulation.”
Can I Start Before Menopause?
Beyond doubts and fears, it is completely understandable that before starting hormonal therapy purely practical questions arise. For example, when is it possible to start with this treatment? Dr. Muñoz recalls that there is no need to wait a year without a period. “Sometimes it is necessary to begin earlier, for example when there are symptoms that cannot be controlled with other treatments or when there are excessive menstrual bleeding with irregular cycles,” he points out.
It is also necessary in cases of premature menopause (before 40). “I always give the same example to my patients: it’s like if your thyroid is removed by surgery and the endocrinologist does not prescribe thyroid hormone. It is evident that a woman whose ovaries have stopped functioning for any reason at an early age has to be treated with the hormones that her body does not produce,” he clarifies.
Bright Prospects
Perhaps patients do not pose this question, but one might wonder whether, after years in oblivion, hormone therapy in menopause can again become trivialized. “I don’t think so… Both patients and doctors are more aware than years ago and I consider it unlikely that we will again see, as I recall from the old days, a patient of 80 who had been prescribed hormone treatment because she reported having a hot flash. It should also be said that current treatments have nothing to do with the doses or safety of those used at the end of the last century,” says Dr. Antonio Muñoz.
Finally, the gynecologist emphasizes that new data are emerging about the beneficial effects of this treatment. “Although less well known, the bone-protective effect and prevention of osteoporosis are more than confirmed. And the most recent data that guide, in some cases, toward protection against dementia and Alzheimer’s in patients who start hormone therapy early. We suppose that, in this case, time will also prove him right.”
