In July of 2002, patients and providers were warned by a Women's Health Initiative study that the use of hormone replacement therapy in postmenopausal women increased the risk of breast cancer and heart disease. Since then, subsequent studies have shown that cardiovascular risk was significantly increased only in women who started hormone-replacement more than 20 years after their menopause.
"Since the 2002 study, there have been other studies of women at different life stages that had different findings. The 2002 (Women's Health Initiative) study was in women 17 years after menopause," said Janet Maxson, nurse practitioner at the Minot Health and Wellness Center. "When it comes to treating women with hormone replacement therapies, the key is to customize it to their risk factors and life stage."
The average age of menopause is 51.3 years, Maxson said, but it can begin two years earlier than average if a woman still has her ovaries but has a hysterectomy. In women who have their ovaries removed and a hysterectomy, the beginning of menopause is immediate.
Katina Tengesdal/MDN - - Janet Maxson, nurse practitioner for the Minot Health and Wellness Center left, and Kathy Edwards, nurse practitioner, discuss information on hormone replacement therapy.
Katina Tengesdal/MDN - - Pictured is a number of hormone replacement therapies available to women.
"The most potent, finest estrogen, estrodial, is made by the ovaries," Maxson said. The organ systems get used to this estrogen, and it's the dominant estrogen before menopause."
After menopause, she said, the body craves estrogen so much it will actually convert fat to estrone, a less efficient form of estrogen.
"When we give a supplement, we're trying to do what your ovaries did," she said.
Many women will seek treatment when menopausal symptoms become troubling. For most, they seek treatment when they begin to have irregular bleeding, hot flashes, changes in sleep patterns or weight fluctuations. They can be treated with hormone replacements for a time to relieve their worst symptoms.
"The fine art of the treatment is customizing the dosages, the delivery methods whether oral or topical, to get them through this acute stage," Maxson said. "The recommendations are to journey them through this stage and to later wean them off."
"What health providers need to do is to customize the therapy to each woman's individual risk factors, whether it is heart disease, osteoporosis, colon or breast cancers, or Alzheimer's," she added.
In addition, Maxson said, symptoms of women who seek treatment during perimenopause, which usually happens in their 40s, may be more easily managed post-menopause.
"During perimenopause is when women undergo a lot of ovarian function changes, and they may have different bleeding schedules or hot flashes then," Maxson said. "Many studies show that how we manage it then has a huge impact post-menopause."
Not all women will need hormone replacement therapies, she said; just those whose symptoms are particularly troubling to them.
"Multiple new evidence-based studies have come out, showing different end points (in hormone therapy treatment) in different age women with different risk factors," Maxson added.
"I'm just a coach," she said. "I can give you some plans, but you have to decide what you would like to do. You have lots of alternatives now that you can choose from don't be afraid of it."