Podcast Summary
Women's Misunderstood Journey Through Menopause: Many women in their 50s and beyond are misunderstood and misinformed about menopause and its treatments, particularly menopausal hormone therapy, leading to unnecessary suffering and confusion.
Women, particularly those in their 50s and beyond, are often misunderstood and misinformed about menopause and its related treatments, specifically menopausal hormone therapy (MHT). Susan Dominus, a staff writer for The New York Times Magazine, shares her personal experience and research in an article from the February 5th, 2023 issue. She and her friends were baffled by the symptoms of menopause and the lack of clear, reliable information available. MHT, a treatment that can significantly improve symptoms for many women, is often misunderstood and has been given a bad rap. Dominus encourages women to educate themselves about this inevitable transition and the potential benefits of MHT. Despite the common suffering and confusion, women have been underinformed about menopause, leaving many to navigate this phase of life with limited resources and understanding.
Menopause: Women's Suffering Overlooked and Undervalued: Menopause brings unique challenges for women, yet treatments like menopausal hormone therapy are underutilized due to misconceptions and stigma. This overlooked suffering can lead to significant loss in quality of life.
Women's experiences and needs during menopause have been overlooked and undervalued in the medical community. The author shares her personal struggle with menopausal symptoms and the lackluster responses from doctors. She then proposes a thought experiment, imagining if men faced similar symptoms, to highlight the disparity in care. Menopausal hormone therapy, a proven treatment for symptoms like hot flashes, sleep disruption, and genitourinary syndrome, has been underutilized due to misconceptions and fear. This oversight has led to unnecessary suffering for millions of women, including loss of sleep, decreased morale, and even depression. Professor Rebecca Thurston believes that menopausal women have been underserved, and the stigma around hormone therapy is a reflection of society's tolerance for women's suffering. The author calls for a reevaluation of women's health during menopause and a renewed commitment to providing effective treatments.
The Controversial History of Hormone Therapy for Menopausal Women: Despite initial beliefs of hormone therapy protecting women from cardiovascular disease, the Women's Health Initiative study revealed increased risks of cardiac events, strokes, clots, and breast cancer, leading to a decline in usage.
The use of hormone therapy among menopausal women, specifically Premarin, saw significant popularity in the US during the late 20th century, but was later revealed to have risks, including an increased risk of endometrial cancer. The belief that hormones could protect women from cardiovascular disease led to a resurgence in prescriptions, despite concerns about safety and insufficient research. The Women's Health Initiative, a large-scale randomized clinical trial, was launched in 1991 to determine the health benefits of hormone therapy. However, in 2002, the study was halted prematurely due to findings of increased risks of cardiac events, strokes, clots, and breast cancer. The communication of these findings caused widespread panic, leading to a decline in hormone therapy use among menopausal women. The importance of rigorous research and clear communication in understanding the potential benefits and risks of medical treatments cannot be overstated.
Contextualizing the Risks and Benefits of Hormone Therapy: While the WHI study reported increased risks of heart disease, stroke, and breast cancer with hormone therapy, the benefits, particularly for women with early menopause, should not be overlooked. More recent research suggests hormone therapy can reduce the risk of osteoporosis.
The Women's Health Initiative (WHI) study, which reported increased risks of heart disease, stroke, and breast cancer associated with hormone therapy, should be contextualized to provide a more accurate and less alarming perspective for the general public. The risks, while significant, need to be weighed against the benefits, particularly for women experiencing early menopause. The study itself had limitations, including a short duration and a bias towards older, less healthy participants. The media coverage of the study triggered widespread panic, leading to a dramatic decrease in hormone therapy use. However, more recent research suggests that hormone therapy, especially for women undergoing early menopause, can offer significant health benefits in terms of reducing the risk of osteoporosis. The full picture of hormone therapy is far more nuanced than the initial alarming headlines suggested.
Newer hormone formulations and delivery methods need more research: Recent studies suggest hormone therapy can benefit women under 60, but doctors should consider individual health histories and risks. Newer hormone formulations and delivery methods require more research.
The Women's Health Initiative (WHI) study, which initially raised concerns about the risks of hormone therapy for women, may not fully apply to women under 60 or in their fifties. More recent research suggests that hormone therapy can have benefits, such as reducing the risk of fractures and diabetes. However, doctors should consider each patient's individual health history and risk factors when making recommendations. Women with certain health conditions, such as heart disease, breast cancer, or a history of blood clots, may be at higher risk from hormone use. For those with mild to moderate symptoms, hormone therapy remains an option, along with other treatments like paroxetine or cognitive behavioral therapy. The decision ultimately depends on the severity of symptoms, personal preferences, and risk tolerance. Doctors are also awaiting FDA approval of a non-hormonal drug for hot flash relief. The WHI study focused mostly on older women and higher doses of hormones, so more research is needed on the safety and effectiveness of newer hormone formulations and delivery methods. Manson's efforts to correct the public perception of hormone therapy have been met with some success, but more needs to be done to ensure women are fully informed of the benefits and risks.
Doctors may lack education on menopausal treatments: Many doctors lack proper education on menopause and its treatments, leaving menopausal women without adequate guidance and potentially exposed to risks.
The complexities and nuances of menopausal treatments, including hormone therapy, often require more time and education than what is typically provided in routine medical visits. Many doctors, particularly younger ones, may not be adequately equipped to discuss the risks and benefits of these treatments due to a lack of education on the subject in medical schools. This can leave menopausal women without the guidance they need to make informed decisions about their health. The consequences of this lack of education can be significant, as hormone therapy, for example, can provide relief for bothersome symptoms but also carries risks, particularly for breast cancer. It is crucial that medical schools prioritize education on menopause and that doctors are given the time and resources to have meaningful conversations with their patients about their options.
Opening up about menopause symptoms: Menopause symptoms extend beyond hot flashes and night sweats, and women may not discuss them due to awkwardness or lack of knowledge. Healthcare providers should initiate conversations about hormonal symptoms to help women make informed choices about their health.
Menopause can be a confusing and challenging time for women, despite it being a stage in life where they may feel a sense of control over their bodies. Many women experience various symptoms, such as depression, osteoporosis, low libido, and pain during sex, but they may not identify these symptoms as menopausal or discuss them with their doctors due to feelings of awkwardness or lack of knowledge. Menopause symptoms are not just limited to hot flashes and night sweats, and a lack of clear language and education about these symptoms can make it difficult for women to make informed choices about their health. Gynecologists, internists, and urologists should initiate conversations about hormonal symptoms with their middle-aged patients to help address this confusion. For some women, the benefits of hormone therapy in managing menopausal symptoms may outweigh any potential risks, even after age 60. Overall, there is a need for more open and informed conversations about menopause and its various symptoms to help women make informed decisions about their health.
Women Experiencing Long-lasting Hot Flashes During Menopause May Face Health Risks: Women who experience frequent and prolonged hot flashes during menopause may be at increased risk for cardiovascular disease and cognitive impairment.
Hot flashes during menopause are not just an inconvenience for some women, but can have significant impacts on their health. A study led by Rebecca Thurston at the University of Pittsburgh found that about 25% of women are "super flashers," experiencing hot flashes for up to 14 years before their periods become irregular. Black women and those with low socioeconomic status were found to experience hot flashes more frequently and for longer durations. Thurston also found that women with more frequent hot flashes (at least 4 a day) had more signs of cardiovascular disease, suggesting a potential link between the two. Pauline Mackey, a professor of psychiatry at the University of Illinois at Chicago, found that hot flashes were associated with mild cognitive changes during menopause, and that the number of hot flashes a woman experiences during sleep is linked to signs of damage to the tiny vessels of the brain. The exact cause-and-effect relationship between hot flashes and these health issues is not yet clear, but doctors should be aware of reports of severe and frequent hot flashes as potential indicators of cardiovascular or cognitive issues.
Menopause and Hormone Therapy: Current State of Research: While hormone therapy can alleviate distressing menopause symptoms, more research is needed to understand its impact on cognitive decline and Alzheimer's disease. Informed conversations with healthcare professionals are crucial when considering hormone therapy.
While research on the role of hormone therapy in cognitive decline and Alzheimer's disease is ongoing, there is currently a lack of definitive evidence and more research is needed. For women experiencing distressing symptoms during menopause, there are various treatments available, including hormone therapy, but it's crucial to have informed and nuanced conversations with healthcare professionals about the potential risks and benefits. The rise of online providers offering hormone prescriptions has created a new avenue for women to access care, but it remains to be seen whether these platforms can fully accommodate the complex decision-making process surrounding hormone therapy. Ultimately, the best approach to menopause care is to prioritize research and ongoing dialogue between women and their healthcare providers.
Impact of Hormonal Treatments on Menopause Symptoms: Personal experiences of improved cognitive function and sleep from hormonal treatments highlight potential benefits, but it's crucial to weigh risks and benefits, especially for younger, healthier women.
Women may be underestimating the impact of hormonal treatments on their symptoms during menopause. The author's personal experience of improved cognitive function and sleep after starting a low-dose birth control pill led her to consider the potential benefits of an intrauterine device (IUD), despite initial hesitation. However, she acknowledges the importance of weighing risks and benefits, especially for those under 60 in good health. Many women may be overlooking or dismissing menopausal symptoms, and the author encourages more open discussions with healthcare providers to explore treatment options. The ongoing research in this area offers hope for more definitive answers and reassurance in the future.
