Although I focus primarily on infertility in this blog, I also wish to expand on other women's issues, such as menopause. A recent article appearing on PBS online, "A New Online Tool Helps Women Track Menopause" caught my eye today. An online interactive tool has been developed by The Endocrine Society called the "Menopause Map". It was developed with the goal of aiding women who suffer from the symptoms of menopause, including hot flashes, sweating, insomnia, mood swings, fatigue, depression and vaginal dryness, among others. As a practicing gynecologist as well as an infertility specialist, I frequently treat women who come to me desperate for help with these sometimes debilitating symptoms. Hormone replacement therapy remains one of the most effective means of controlling and sometimes eliminating these symptoms. According to the guidelines set by my specialty (ACOG), a common treatment may include taking HRT commencing when symptoms begin (typically when women are in their late 40's early 50's) and continuing on this regimen for as short a period as possible.
In my mind, the benefits from HRT are many and worth considering. I have had years of feedback from my patients saying how it has helped them tremendously, not only with their mood swings, but also with their energy levels and their intimacy with their partner. I also believe that Estrogen, the main hormone in HRT, is essential to a woman's body. There are benefits beyond the symptoms of menopause such as a reduction of heart disease, osteoporosis, vaginal dryness and thinning, emotional ability and Alzheimer's. Women are the most healthy during the years that they have lots of Estrogen aboard. It only makes sense that they will remain healthier if they continue to have estrogen in my belief and experience. So, despite ACOG's recommendations, I explain to my patients that there is no study or data that says "when" HRT is to be stopped and because of increasing longevity, they should continue it indefinitely.
The Endocrine Society has released the results of a poll they recently conducted revealing that an astounding 72% of women do not seek assistance or therapy for their menopausal symptoms! One big reason for this lies in the repercussions of the Women's Health Initiative study of 2002. The NIH sponsored Women's Health Initiative (WHI) was done to evaluate the impact of HRT on heart disease but instead came out condemming the use of hormone replacement therapy for women who are suffering from menopause because of a statistically insignificant increase in peast cancer, only in women who had taken a combined estrogen-progesterone drug called Prempro.
The WHI has since been refuted many, many times and shown to have been flawed in part by focusing on women in their 60's and 70's, long after menopause has ceased to be an issue. The beneficial aspects of HRT for women in their 50's were not considered as part of the study. According to Dr. Cynthia Stuenkel, an endocrinologist who specializes in menopause and one of the creators of this new tool, "Our current thinking is that for healthy women in their 50s -- women who have not had peast cancer or a history of blood clots -- and have been experiencing the symptoms of menopause for less than 10 years, hormone therapy can be very effective for symptom relief and overall is quite safe." Other recent studies have in fact shown beneficial effects to heart disease and other long term problems, mentioned above, if the replacement starts within 5 years of the onset of menopausal symptoms. Patients not requiring the progesterone component, because they don't have a uterus, and who take only estrogen, have been shown to have a decrease in peast cancer incidence. The media seems to focus on an anti-HRT program when in fact, medically, the many benefits HRT provides continues to be proven with newer and newer studies.
I am pleased to see PBS Newshour bucking the trend and instead, promoting awareness in this very important issue to women both in the United States and all over the world.
