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Is hormone therapy the cheat code to perimenopause? · Silver FM 100.6

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  Speaker 3: And it seems like there's been a big shift in
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  Speaker 3: the past few years in the way that women talk
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  Speaker 3: about menopause and perimenopause. Honestly, I feel like even seeing
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  Speaker 3: women talk about it at all, that's new.
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  Speaker 4: It is totally new, and I've noticed it as a
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  Speaker 4: woman who just turned forty and as a doctor. You know,
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  Speaker 4: when I learned about menopause in medical school fifteen years ago,
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  Speaker 4: I learned that hormone therapy was dangerous and should be
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  Speaker 4: avoided at all costs. And I learned that the symptoms
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  Speaker 4: of menopause were no big deal and that women should
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  Speaker 4: just deal with them. And the tide is turning. I
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  Speaker 4: think people are really eager for treatment. They're really eager
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  Speaker 4: for open conversations about this period of life. And the
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  Speaker 4: science is changing, right, The science is showing that actually
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  Speaker 4: hormone therapy is much safer than we thought fifteen years ago.
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  Speaker 3: Hey, it's Mary el Segarta. You're listening to Life Kit,
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  Speaker 3: And that was doctor Mara Gordon. She's a family medicine
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  Speaker 3: doctor and the author of NPR's Real Talk with the
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  Speaker 3: Doc column. We're talking about hormone therapy, which is a
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  Speaker 3: way to treat the symptoms of perimenopause and menopause like
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  Speaker 3: hot flashes, which can interrupt your sleep and make your
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  Speaker 3: day to day life miserable. You're at work, for instance,
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  Speaker 3: and you suddenly start sweating profusely in a situation where
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  Speaker 3: no one else is sweating. It's the constant like take
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  Speaker 3: the sweater off, put it back on, because now you're cold.
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  Speaker 3: After it's over, you're covered in sweat and you're cold.
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  Speaker 4: It can really really disrupt your quality of life.
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  Speaker 5: All right, some quick definitions here.
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  Speaker 3: Menopause is defined as a year with no menstrual bleeds,
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  Speaker 3: although that definition can be confusing for women who already
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  Speaker 3: don't have a mentrual bleed, whether that's temporary or permanent.
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  Speaker 3: Maybe they've gone through cancer treatment or surgery, or they
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  Speaker 3: have pmos. In those cases, doctors may say, yes, you're
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  Speaker 3: probably in menopause based on your age and your symptoms
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  Speaker 3: and sometimes a blood test.
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  Speaker 5: So that's menopause.
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  Speaker 3: And then perimenopause is the period leading up to menopause.
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  Speaker 4: It's the period of hormonal shifts that start to occur
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  Speaker 4: as women approach menopause, and it is different for every woman.
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  Speaker 4: When perimenopause starts. I mean, there are hormonal changes up
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  Speaker 4: to ten years before menopause, but I would say typically
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  Speaker 4: people are experiencing the most symptoms that sort of bring
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  Speaker 4: them to the doctor and say, hey, you know, I'm
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  Speaker 4: experiencing hot flashes, I'm experiencing sleep disturbances, I'm experiencing, you know,
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  Speaker 4: change in my mental focus, in my mood. Those I
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  Speaker 4: would say are typically three to five years before the
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  Speaker 4: onset of menopause. But again, every woman's different, and I
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  Speaker 4: have people coming to me in their early forties asking
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  Speaker 4: about symptoms and saying, hey, is this perimenopause.
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  Speaker 3: One suggestion that I've seen a lot, especially on social media,
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  Speaker 3: is to do hormone therapy if you're going into perimenopause
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  Speaker 3: or menopause, what does hormone therapy involve?
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  Speaker 4: So when doctors talk about hormone therapy from menopause, we
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  Speaker 4: are typically talking about taking a medication that involves an
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  Speaker 4: estrogen and a progestogen. And estrogen and progesterone are two
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  Speaker 4: hormones that are created in the body and they tend
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  Speaker 4: to decline as women approach menopause, and as they decline,
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  Speaker 4: women experience a lot of different symptoms, most notably hot
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  Speaker 4: flashes or sort of the classic menopause symptom that women
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  Speaker 4: experience as the estrogen and progesterone decline. So in order
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  Speaker 4: to treat those symptoms, doctors offer an estrogen and what's
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  Speaker 4: called a progestogen, and progestogen just includes progesterone which is
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  Speaker 4: made in the body, and what are called progestines which
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  Speaker 4: are synthetic progesterones. And most women will take a combination
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  Speaker 4: of an estrogen and a progestogen in order to treat
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  Speaker 4: the symptoms of menopause as their hormones decline and they
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  Speaker 4: approach their last period and Menopauseal hormone therapy can come
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  Speaker 4: in different forms, so sometimes people will take pills by mouth.
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  Speaker 4: Sometimes people will use a patch there are creams. IUDs
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  Speaker 4: are considered a progestogen because they emit a progestine. It
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  Speaker 4: can help with menopausal symptoms. So there's tons of different
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  Speaker 4: options when we talk about menopausal hormone therapy, but they're
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  Speaker 4: typically involving those two hormones.
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  Speaker 3: And what is hormone therapy good at treating? Which symptoms
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  Speaker 3: of perimenopause or menopause.
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  Speaker 4: So hormone therapy is really, really, really good at treating
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  Speaker 4: hot flashes. So the technical term for hot flashes is
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  Speaker 4: called vasomotor symptoms. It's usually hot flashes and night sweats
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  Speaker 4: which affect a large percentage of women as they approach menopause,
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  Speaker 4: and hormone therapy is really really good at taking those away.
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  Speaker 3: I just want to pause here and say they're terrible.
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  Speaker 3: I went through I've gone through them. I have them
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  Speaker 3: still sometimes because of breast cancer treatment.
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  Speaker 5: Yeah, but have you experienced them?
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  Speaker 4: I have not, but my patients tell me about them,
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  Speaker 4: and they can be really debilitating and they can really
• 5:57
  Speaker 4: disrupt your quality of life.
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  Speaker 3: Yeah, it makes it hard to sleep. I don't know
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  Speaker 3: if that has come up for your patients. If you're
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  Speaker 3: death waking up soaked in sweat, you know every hour
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  Speaker 3: you're never getting that RESTful sleep that you need.
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  Speaker 4: Totally, and sleep is so important. We need it to
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  Speaker 4: function to feel like humans. And so to take that
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  Speaker 4: seriously as a doctor and to be able to offer
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  Speaker 4: my patient something that helps them feels really good. So
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  Speaker 4: hormone therapy can also help with what's called the genata
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  Speaker 4: urinary syndrome of metopause. This is extremely common in perimenopause
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  Speaker 4: and after the menopausal transition, and basically the vulva becomes
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  Speaker 4: sort of dried out and it can be really uncomfortable
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  Speaker 4: for women to have sex. It can cause symptoms that
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  Speaker 4: feel like an urinary attract infection. It can cause urinary
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  Speaker 4: tract infection, so hormone therapy can really really help with that.
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  Speaker 3: Hormone therapy can be an effective treatment for these symptoms,
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  Speaker 3: particularly hot flashes and pain in your urinary tract or
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  Speaker 3: your vulva. Mara has also reported that it can lower
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  Speaker 3: the risk of fractures for women who have a high
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  Speaker 3: risk of osteoporosis, and it can help keep bones strong,
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  Speaker 3: but that most medical organizations don't recommend it for that
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  Speaker 3: purpose alone.
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  Speaker 5: But of course it.
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  Speaker 3: Comes with risks and the thinking about those risks has
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  Speaker 3: changed as we've learned more. We'll talk about that after
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  Speaker 3: Another supposed benefit of hormone therapy that folks may have
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  Speaker 3: seen is that it can lower your risk of heart disease?
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  Speaker 5: Is that true?
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  Speaker 4: So again, fifteen years ago, when we thought that hormone
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  Speaker 4: therapy was much riskier than it actually turns out to be.
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  Speaker 4: The reason we thought it was so scary was because
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  Speaker 4: a lot of the studies that initially examined the outcomes
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  Speaker 4: with hormone therapy looked at much older women using it,
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  Speaker 4: so women in their sixties, even in their seventies. And
• 9:39
  Speaker 4: we found back then that taking hormone therapy when you're
• 9:44
  Speaker 4: ten years from menopause actually can increase your risk of
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  Speaker 4: cardiovascular disease. And so that's why doctors were so scared
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  Speaker 4: of it. And what's now emerging in the science is
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  Speaker 4: something that doctors call the timing hypothesis, which means the
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  Speaker 4: time of life in which you use hormone therapy really
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  Speaker 4: really matters for outcomes. So, actually using hormone therapy for
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  Speaker 4: women in their forties and fifties, right around the time
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  Speaker 4: when women transition into menopause and often their symptoms are
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  Speaker 4: most pronounced. There's a lot of open questions about whether
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  Speaker 4: or not hormone therapy might actually be protective of the
• 10:21
  Speaker 4: heart during this period, but the science isn't there to
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  Speaker 4: be able to promise that to women.
• 10:27
  Speaker 3: Take away too. Hormone therapy is recommended as a treatment
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  Speaker 3: for the symptoms of perimenopause and menopause, but any other
• 10:33
  Speaker 3: promises you've heard that it'll protect you against heart disease
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  Speaker 3: or help you live longer, that's just not proven. And
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  Speaker 3: the US Preventative Services Task Force, the American College of
• 10:43
  Speaker 3: Obstetricians and Gynecologists, and the Menopause Society do not recommend
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  Speaker 3: hormone therapy for longevity, heart health, or preventing chronic conditions
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  Speaker 3: based on the data they have now. Also, it seems
• 10:55
  Speaker 3: that hormone therapy might carry different risks depending on your age,
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  Speaker 3: So for this younger age range in your forties, fifties.
• 11:05
  Speaker 3: How risky is hormone therapy considered to be now, and
• 11:09
  Speaker 3: what are the risks.
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  Speaker 4: So hormone therapy does have some risks, and it's really
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  Speaker 4: important to be open about it with patients and have
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  Speaker 4: that discussion about the risks and benefits so that people
• 11:22
  Speaker 4: can make an informed decision. So typically a woman who
• 11:26
  Speaker 4: has had breast cancer herself, I would say, let's proceed
• 11:31
  Speaker 4: with caution because there is some data to suggest that
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  Speaker 4: hormone therapy can increase the risk of breast cancer recurrence.
• 11:39
  Speaker 4: A woman who has had a blood clot I would
• 11:42
  Speaker 4: proceed with caution because hormone therapy can increase the risk
• 11:46
  Speaker 4: of blood clots. And a woman with really active cardiovascular disease,
• 11:50
  Speaker 4: somebody who had a heart attack within a year something
• 11:53
  Speaker 4: like that, I would say, let's proceed with caution and
• 11:57
  Speaker 4: hold off. And in those patients, I wouldn't say, hey,
• 12:01
  Speaker 4: you have to live with this, you know, like just
• 12:04
  Speaker 4: deal with your hot flashes. We actually have lots of
• 12:06
  Speaker 4: non hormonal treatments for vasomotor symptoms that can really help people,
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  Speaker 4: and often I'll even try those in patients who have
• 12:15
  Speaker 4: some concerns about metapausal hormone therapy, they aren't sure if
• 12:18
  Speaker 4: they want to try hormones but they're still having symptoms,
• 12:20
  Speaker 4: will say, okay, let's try another medication that is not
• 12:25
  Speaker 4: hormones first, And people often find that their symptoms totally
• 12:29
  Speaker 4: go away without even needing to use hormones.
• 12:33
  Speaker 3: And yeah, I mean it depends on the symptom, right,
• 12:36
  Speaker 3: you have to treat the hot flashes specifically and then
• 12:40
  Speaker 3: the general urinary symptoms specifically. If you fall into one
• 12:44
  Speaker 3: of these higher risk categories where hormone therapy at least
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  Speaker 3: systemic hormone therapy wouldn't be a good idea for you.
• 12:51
  Speaker 3: What about the localized kind, like an estrogen cream if
• 12:55
  Speaker 3: you're having painful sex.
• 12:58
  Speaker 4: Local low estrogen cream that's used in the vagina is
• 13:02
  Speaker 4: safe for almost everybody, So even if you have had
• 13:06
  Speaker 4: breast cancer, even if you have serious heart disease, local
• 13:11
  Speaker 4: estrogen that's used to treat the genet to urinary symptoms
• 13:16
  Speaker 4: totally safe because it's not absorbed throughout the whole body,
• 13:18
  Speaker 4: so it doesn't affect the organs that might be at
• 13:23
  Speaker 4: higher risk from systemic hormone therapy. I would also offer
• 13:30
  Speaker 4: certain classes of antidepressants can be helpful to treat hot
• 13:33
  Speaker 4: flashes called SNRIs and can really really help reduce hot
• 13:38
  Speaker 4: flashes and night sweats, So I'll often recommend that as
• 13:41
  Speaker 4: my first line treatment to women who have one of
• 13:45
  Speaker 4: those conditions that might make hormone therapy a little bit riskier.
• 13:49
  Speaker 4: And there's a medication called Vioza that was FDA approved
• 13:54
  Speaker 4: in twenty twenty three, and it can really help reduce
• 13:57
  Speaker 4: hot flashes and it can pas no hormones, so it's
• 14:01
  Speaker 4: safe for women who have one of those conditions that
• 14:04
  Speaker 4: might make hormones higher risk. I don't prescribe it much
• 14:07
  Speaker 4: because it's often quite expensive, but that's another option that
• 14:11
  Speaker 4: hopefully will become more affordable in the coming years.
• 14:16
  Speaker 5: Take Away three.
• 14:17
  Speaker 3: If you have a history of breast cancer or blood
• 14:20
  Speaker 3: clots or some other conditions, your doctor will likely not
• 14:23
  Speaker 3: recommend systemic hormone therapy, but.
• 14:26
  Speaker 5: That doesn't mean you have to suffer.
• 14:27
  Speaker 3: Local estrogen cream maybe inappropriate treatment if you're having pain
• 14:31
  Speaker 3: in your urinary tract or your volva. And there are
• 14:34
  Speaker 3: other medications you can take for hot flashes, including SNRIs
• 14:38
  Speaker 3: and a drug called Viosa. What about other kinds of
• 14:42
  Speaker 3: treatments like acupuncture, or certain supplements. Both of those were
• 14:46
  Speaker 3: recommended to me by my cancer hospital.
• 14:48
  Speaker 4: I mean, I think with all of these treatments that
• 14:53
  Speaker 4: don't have a ton of research on them, I think
• 14:57
  Speaker 4: we just don't know what the evidence is going to show,
• 15:00
  Speaker 4: and I don't want to dismiss them out of hand.
• 15:03
  Speaker 4: If acupuncture is helpful for my patient by all means
• 15:07
  Speaker 4: to acupuncture, you know, if a supplement is helpful for
• 15:10
  Speaker 4: my patient and it's affordable to you by all means.
• 15:13
  Speaker 4: I think what I take issue with is a lot
• 15:17
  Speaker 4: of companies really aggressively market these treatments that don't have
• 15:21
  Speaker 4: a ton of science to back them up, and sort
• 15:24
  Speaker 4: of over promise on what they can offer people. And
• 15:28
  Speaker 4: that's when I say, hey, you know, don't don't don't
• 15:32
  Speaker 4: take advantage of the fact that there's this swelling of
• 15:36
  Speaker 4: interest around menopause. Don't don't abuse it. We're we've earned
• 15:40
  Speaker 4: women's trust back, we meaning healthcare providers. We're slowly earning
• 15:44
  Speaker 4: back the trust of women and saying hey, we take
• 15:47
  Speaker 4: your symptoms seriously, we take your concerns seriously, and we
• 15:51
  Speaker 4: want to treat them with evidence based treatments. And when
• 15:56
  Speaker 4: you know, companies come in and say, here, buy this
• 15:58
  Speaker 4: stuff that I am marketing and making a lot of
• 16:02
  Speaker 4: money off of. We lose women's trust if it isn't effective.
• 16:09
  Speaker 3: What would you say to a woman who's experiencing these
• 16:14
  Speaker 3: symptoms of perimenopause and not making headway and getting treatment.
• 16:21
  Speaker 3: Maybe their doctor is dismissing their concerns, or maybe they
• 16:25
  Speaker 3: just like haven't found the right treatment for them yet.
• 16:29
  Speaker 4: In that scenario, I would recommend that somebody look for
• 16:35
  Speaker 4: doctors who have gotten certified by the Menopause Society. So
• 16:39
  Speaker 4: the Menopause Society is an organization that offers training resources,
• 16:45
  Speaker 4: lots of up to date information about menopause. It's really
• 16:48
  Speaker 4: where I go to look up the most evidence based
• 16:52
  Speaker 4: and up to date science about menopause. And doctors can
• 16:57
  Speaker 4: take a test that gets them certified with the Menopause
• 17:00
  Speaker 4: Society and says, hey, this doctor really knows what they're
• 17:04
  Speaker 4: doing when it comes to menopause care. And that's a
• 17:07
  Speaker 4: good place to start looking for a doctor who has
• 17:09
  Speaker 4: that certification in your area. And there's a lot of
• 17:11
  Speaker 4: telehealth companies that offer menopause care, which is really cool
• 17:15
  Speaker 4: now that we have the technology to be able to
• 17:17
  Speaker 4: offer telehealth services. Menopause care is something that really lends
• 17:22
  Speaker 4: itself to telehealth because a lot of it is just
• 17:26
  Speaker 4: talking with my patients and understanding what their symptoms are.
• 17:29
  Speaker 4: There's often not that much that changes with a physical
• 17:32
  Speaker 4: exam in terms of the recommendations I make, so finding
• 17:35
  Speaker 4: a telehealth provider who is Menopause Society certified is another
• 17:40
  Speaker 4: good way to go.
• 17:41
  Speaker 3: Mara, thank you so much for this, my pleasure.
• 17:44
  Speaker 5: All right, all time for a recap. Take Away one.
• 17:47
  Speaker 3: Hormone therapy can be an effective treatment for the symptoms
• 17:50
  Speaker 3: of perimenopause and menopause, particularly hot flashes and pain in
• 17:54
  Speaker 3: your urinary tract or your vulva, But of course it
• 17:58
  Speaker 3: comes with risks, and the thinking about those risks has
• 18:00
  Speaker 3: changed as we've learned more.
• 18:02
  Speaker 5: Take Away two.
• 18:03
  Speaker 3: Any other promises you've heard about hormone therapy that it'll
• 18:06
  Speaker 3: protect you against heart disease or help you live longer,
• 18:09
  Speaker 3: That is not proven. Also, it seems that hormone therapy
• 18:12
  Speaker 3: might carry different risks depending on your age.
• 18:16
  Speaker 5: Take Away three.
• 18:17
  Speaker 3: If you have a history of breast cancer or blood
• 18:19
  Speaker 3: clots or some other conditions, your doctor will likely not
• 18:23
  Speaker 3: recommend systemic hormone therapy, but that doesn't mean you have
• 18:26
  Speaker 3: to suffer.
• 18:26
  Speaker 5: Local estrogen cream may be.
• 18:28
  Speaker 3: Inappropriate treatment if you're having pain in your urinary tract
• 18:31
  Speaker 3: or your vulva, and there are other medications you can
• 18:33
  Speaker 3: take for hot flashes, including SNRIs and a drug called vioza. Lastly,
• 18:39
  Speaker 3: if you're having symptoms of what you think is perimenopause
• 18:41
  Speaker 3: and you can't seem to get treatment, look for a
• 18:44
  Speaker 3: doctor who's certified by the Menopause Society, and if there
• 18:47
  Speaker 3: isn't one in your area, consider a telehealth visit because
• 18:50
  Speaker 3: you may not need a physical exam to get help.
• 18:54
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  Speaker 3: This episode of Life Kit was produced by Kayla Lattimore.
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  Speaker 5: I'm Mariol Sagara. Thanks for listening, Tanya.
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  Speaker 9: I think you did the best to interview that I've done.
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  Speaker 4: Seriously, Oh that's a great question.
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  Speaker 5: I thinking I want to think about that question for
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  Speaker 5: the rest of my life.
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