A Pause in Treatment
A recent article in the New York Times had an intriguing title – “Women Have Been Misled About Menopause.” (NYT February 1, 2023, Susan Domnus)
The author, herself in anticipation of a perimenopausal state, spoke to a number of her friends who had experienced a variety of symptoms including mood changes, hot flashes, dry skin, vaginal pain and dryness, memory changes and difficulty with sleep. Many of her friends’ complaints were discounted by their health care providers. She offers the explanation that “We have a high cultural tolerance for the suffering of women.”
She explains that women are not often offered hormone replacement therapy (HRT). In part, this fear of HRT started in 2002 when a large study called the Women’s Health Initiative highlighted the risks of HRT. The fear of prescribing HRT persisted even though many other options are now available that do not have the adverse effects of the older treatments. Hormone replacement is now more “bioidentical”, that is, closer to our own hormones. Delivery systems have changed and can be given as patches to avoid passing the medication through the liver. Nonetheless, the reluctance to start medication has persisted in both women and physicians.
There are two important developments from current research.
- Younger women, especially those who go through menopause earlier than the average age of 51, have low risks of side effects of HRT. The highest risks of HRT are in women who start HRT over the age of 60.
- There are positive effects of HRT. There is a lower chance of fracturing bones from osteoporosis and there is a lower risk of diabetes in women on HRT. The risk of breast cancer is less alarming than it was first thought.
Individual risk factors need to be assessed and a “goals of care” discussion with your primary care provider is important to decide what is best for you. I would not agree that women have been misled but, rather, both care providers and women need to reevaluate in light of current evidence. After all, that is what the evolution of science demands of us!
Dr. Bhooma Bhayana is a family physician in London and the mother of two young men and proud grandmother of three! She continues to find wonder and enjoyment in family practice despite more than 30 years on the job!
