By Diana Bitner, MD, Spectrum Health Beat

Too many women suffer needlessly from symptoms of hormone changes and menopause.

Women want to age with health and vitality, but often are taken by surprise with midlife body changes. It is unfortunate that not enough women know the facts about hormones and options for healthy aging.

We are fortunate these days because there are so many treatment options available.

There has been significant research to help us understand how to individualize these options for each woman depending on her preferences, medical history, stage of menopause and degree of symptoms.

Options abound

The foundation of treatment for the symptoms of menopause is a healthy lifestyle. This is defined by the SEEDS, or seven essential elements of daily success.

Following the SEEDS each day includes:

• Eighty ounces of water
• Seven hours of sleep
• A healthy balance of healthy carbs, protein and fats with only one unhealthy carb treat
• A multivitamin and vitamin D
• Exercise and stretching
• Fiber
• Calm breathing and gratitude

For some women, this is enough to feel good through menopause. Twenty percent of women get through their transition with only minimal symptoms.

For many women, however, a healthy lifestyle is not enough. They feel so in the hole of symptoms that they want some kind of treatment to help them feel better and get back into good habits. This is when we talk about the most effective treatment for hot flashes, night sweats, pain with sex, sleep and mood disturbances and decreased sex drive.

Estrogen medication works quickly and is safe for many women. There are many fear-based untruths out there that keep women from using medication that can help them feel like themselves again.

A recent study of hormone use showed that the risk of blood clots has a higher association with oral estrogen use, not with transdermal—absorbed through the skin—estrogen therapy. And for oral estrogen use, the risk was higher with equine estrogen, also known as premarin, and not with the bioidentical, FDA-approved form of estrogen.

Now, for women who have taken premarin for years and do not want to stop, the risk of associated blood clots is mainly in the first year. Switching is possible, but for those women who choose not to, the advice would be to minimize other risks for blood clots by maintaining a healthy weight, staying hydrated, and taking a baby aspirin when on long car trips or plane rides. And always talk to your doctor about your risk.

Bottom line, be informed, make decisions based on facts, and get advice from doctors and other health care providers who are menopause certified. Every woman is different and what works for her or is safe for her may not apply to another.

Test your hormone knowledge

True or false? Hormones will make me fat.

False. Menopause is associated with belly fat, hormone medications are not. Studies show that hormone medication may help with sleep and reduce insulin resistance, so if women do the work to stay healthy, hormones can help maintain a healthy weight.

True or false? Estrogen causes breast cancer.

False. In the aforementioned study, women who were on estrogen because they had a hysterectomy had a lower risk of breast cancer. Estrogen does not cause cancer, but if a woman gets breast cancer, we do not give estrogen in the blood (via a patch or pill) because of concerns it could cause a recurrence. We might prescribe vaginal estrogen, but not systemic. The only women in the Women’s Health Initiative study with more breast cancer were older and on synthetic oral progesterone more than seven years. This study helps us understand safe ways to give hormones and which type.

True or false? Prescription medication is not bioidentical.

False. It is biochemically identical to the estrogen the ovary makes before menopause. We prescribe FDA-approved estrogen and progesterone, meaning it is the same every time you place a patch or take a pill. There is no batch-to-batch variability like in the compounded medications. Insurance will cover the FDA-approved medication.

Hormone guidelines to consider

If the below criteria describes you, hormones could be a safe option:

• Less than 10 years from last period
• No history of breast cancer
• No vascular heart disease (heart attack, or high risk for heart attack)
• No history of blood clot in the leg or lung
• No prior stroke
• No dementia
• No metabolic syndrome (combo of high blood pressure, central obesity, high blood sugar, high cholesterol)

These are only guidelines. If there are any questions regarding risk, your provider will bring in partners from cardiology, diabetes, hematology, and cancer care to help guide decisions.

Reprinted with permission from Spectrum Health Beat.

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