“I knew I was in trouble when my 95-year-old patient suddenly got up to get a fan for me—I was sweating that much,” recalls Joanne Cubberly of Chesterton, a physical therapist for an area home health care agency. “That pushed me over the edge (to seek hormone therapy).
Today Cubberly can chuckle at the memory from about two months ago, but for her and for many other women, hot flashes and other symptoms of menopause can be so severe that they interfere with daily life. They face making choices that some can find confusing: Do they drink a special tea? Order pills from the Internet? Ask for estrogen-replacing therapy? Leave it up to the doctor?
The questions became more troubling a few years ago when the media reported that a study showed an increase in the risk for breast cancer in patients who had hormone replacement therapy. But that wasn’t the whole story. Dr. Lovera Wolf Miller, whose Michigan City, Ind., practice is through IU Health La Porte, explains, “Those reports didn’t tell us that the increased risk wasn’t statistically significant.” Miller, co-author with her husband, Dr. David C. Miller, of the book, “Womenopause: Stop Pausing and Start Living,” notes that “A recent global consensus statement from several organizations said the benefits of hormones outweigh the risk, if you begin within 10 years or so of the onset of menopause, or before age 60.”
Wolf Miller said the statement also included that breast cancers only increased with the use of progestegen as opposed to progesterone, and that the dose and duration of treatment should be tailored to each patient.
“Historically it was the approach to (administer some form of hormone therapy) forever, but now it’s an individualized approach,” says Angie Tursman, nurse practitioner at Prima Bella Women’s Health in Valparaiso with Dr. Mary Ann Jones. “Hormone imbalances can occur in women in from the age of 30 to the late 60s. It’s an evolving process; as we get better or make healthy lifestyle changes, sometimes women don’t need it anymore.”
Dr. Kimberly Arthur at Community Care Network-Hessville Family Care Center
recommends hormonal replacement therapy for people with hot flashes, for a limited time—one or two years. “Usually the hot flashes last up to two years, though some patients complain of them for years.”
What about “natural,” bioidentical, and synthetic hormone replacement therapies? The difference between the terms can be confusing; bioidentical means the plant-based molecular structure is the same as the hormone produced in the body, but there are differing definitions about what constitutes “natural.” It’s a discussion best held with your physician for clarification. For example, “Bioidentical is believed by some to be safer,” says Tursman, “but it’s still a hormone. So a patient with a personal history of cancer—not a relative’s—may not be a candidate (for that treatment).” And, “Synthetic doesn’t mean it’s not natural,” says Wolf Miller, who uses soy- and yam-based products. That doesn’t mean you can pick a soy and/or yam-based “natural” product off the shelf with confidence, because not all are FDA-approved. “I only use the one that’s FDA-approved,” cautions Wolf Miller.
As for the effectiveness of soy and yam products, Arthur says, “It’s half and half: Some patients say it helps, some say it doesn’t.” It’s Arthur’s initial go-to treatment for hot flashes and other post-menopausal symptoms.
Whichever substance is chosen, “You want to use the least amount of hormone to increase quality of life,” says Tursman.
Another choice is between oral and transdermal—through the skin. “I only use transdermal,” says Wolf Miller. Methods of application include a spray for the arm, a patch for the tummy, and a ring form that’s inserted. “If you don’t want estrogen in your system, a local vaginal estrogen in cream form can reverse dryness, irritation, and discomfort during intercourse,” says Wolf Miller. “The side effect can be some breast tenderness, which usually goes away. If not, I switch—it’s not one size fits all.”
Before trying any menopause hormone treatment, “A thorough medical history by a nurse practitioner or doctor is essential,” says Tursman. “People don’t need to be afraid of hormone replacement therapy, particularly when it is administered in the right amount” and other considerations.
As for reducing the risk for breast cancer and for promoting overall health, Wolf Miller recommends 100 minutes of exercise each week and plenty of green vegetables and Vitamin D every day.