A new paper in the Canadian Medical Association Journal reviewed treatment considerations during menopause and has listed hormone therapy as a first-line treatment. This means, unless there is a specific contradiction or patient preference, it should be considered and offered as the first treatment tried.

What is menopause and why would we consider treatment?

Menopause is defined as one year without a period, with the average age being 51 years old. This results in a significant drop in hormones, such as estrogen and progesterone, and for as many as 80% of women, it can lead to substantial symptoms like hot flashes, night sweats, mood swings, sleep disturbance, or genitourinary symptoms. 

Most of these symptoms can start long before menopause. On average, symptoms can begin 7 years prior to the final period, and 25% of women, can experience symptoms for as long as 10 or more years. 

These symptoms can significantly impact the quality of life. 

Treatment with hormone therapy has been shown to improve vasomotor symptoms (hot flashes, night sweats) by as much as 90%. It has also been shown to enhance the quality of sleep and mood disturbance. Additionally, menopausal hormonal therapy may show a possible reduction in coronary artery disease, improvement in lipid profile, and reduction in osteoporosis-related fractures.

Why is this new paper so exciting?

This paper does a nice job of outlining the benefits vs risks and concludes that hormone therapy is the first-choice therapy for vasomotor symptoms (i.e. hot flashes, night sweats) in the absence of contraindications. It also does a great job of addressing previous concerns on hormone therapy, including cardiovascular risk, and breast cancer risk. They report on updated studies that address those previously thought findings and advise an individual-based approach when considering treatment.

The paper concludes that hormone therapy should be considered first-line treatment in those under 60 years old, in the absence of contraindication.

What are the contraindications for hormone therapy?

• Undiagnosed abnormal vaginal bleeding
• Known, suspected, or history of breast cancer
• Known, suspected, or history of estrogen-dependant cancers
• Active or history of coronary artery disease
• Active or history of venous thromboembolism
• Active or history of stroke
• Known thrombophilia
• Active liver disease

These risks should be discussed prior to initiating therapy and discussed on an individual basis.

How do you start hormone therapy?

It’s important to talk to a qualified healthcare provider with experience in supporting you through treatment. Prior to starting hormone therapy, we discuss risks and benefits, we calculate your individual risks for fracture, heart disease, and breast cancer, and we run applicable blood work that allows us to monitor any changes that may occur when initiating hormones. This allows us to monitor your risk and make confident, informed decisions.

We start slow and monitor progress to make sure you are achieving benefits, minimizing any side effects, and progressing with the lowest possible dose. Hormones are highly individualized, as they should be, and therefore adjustments of dosage are often a consideration when we follow up.

How do I know if hormone therapy is right for me?

There has been a long-standing fear of hormone therapy, leaving many women without suitable treatment options during perimenopause and menopause, ultimately resulting in poor quality of life. This paper wonderfully addresses the fears, risks, and benefits and clearly states hormone therapy as an effective, safe, and individualized treatment consideration so women do not need to suffer.

If you’re over the age of 40 and noticing hormonal disturbances, reach out. There are effective and safe options to help you navigate this period of time.

It is my goal to make sure you are fully informed of all your options. If you’d like more information, schedule a discovery call to learn more.

In Health,

Dr. Ashley Damm, BSc. ND

References:

Lega IC, Fine A, Antoniades ML, Jacobson M. A pragmatic approach to the management of menopause. CMAJ. 2023 May 15;195(19):E677-E672. doi: 10.1503/cmaj.221438. PMID: 37188372; PMCID: PMC10185362.