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The Doctor's Corner: Get informed on menopausal hormone therapy

June 21, 2012|By Jane Bening

EDITOR'S NOTE: This is the second in a three-part series on menopausal hormone care.

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The following is a hypothetical but typical scenario.

Leann is a 50-year-old woman whose menstrual periods have stopped. She is gaining weight, flashing all night and devoid of sex drive. Her brain is in a fog. Ralph, her husband, is beleaguered by his wife's crabby, Gorgon-like transformation. She repeatedly rejects his sexual advances. Leann's attitude is, "It's painful, but then who cares anyway?" She is terrified of menopausal hormones. Her general doctor encourages her to "tough it out," feeding her fears that hormone therapy would make her gain more weight and cause breast cancer.

In deciding what medical advice to give Leann, it is helpful to look at recent reputable expert opinions. New, slightly more permissive guidelines were published in March in "Menopause: The Journal of the North American Menopause Society". To disclose, I have been a medical speaker for pharmaceutical manufacturers of bioidentical estrogen.

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As previously noted in my first article in this series, the North American Menopause Society Advisory Panel on hormone therapy made a landmark conclusion from the extensive study known as the Women's Health Initiative that estrogen therapy did not increase breast cancer risk.

Here is a summary of the other advisory panel conclusions and recommendations, based on their review of the health initiative , and other recent relevant medical research, regarding use of hormone therapy in the menopause:

1) Individualization of therapy is key in the use of hormone therapy.

2) Recommendations for duration of hormone therapy vary depending on whether artificial progesterone is used.

3) Low-dose, local, vaginal estrogen therapy is advised when only vaginal symptoms are present.

4) Candidates for hormone therapy can use it until at least age 51, or longer if needed for symptoms (think of Leann).

5) Scientific evidence has not yet proven that different estrogen therapy regimens are safer than those used in the health initiative , although estrogen therapy in lower doses, given across the skin has been associated with less risk of blood clots in veins and stroke.

6) Compounded hormone therapy regimes are not recommended unless the patient has allergies to government-approved products.

Visit the NAMS website at http://www.menopause.org.

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