My Views on The Use of Hormone Therapy Among Women

As a female woman in the center of young adulthood my mind is looking forward to the next steps in aging. I know it may be far away but working in a senior care center my mind skips past middle adulthood and looks instead to late adult hood. I see the young old all the way to the oldest old in the care facility I’m in. And this class has opened my eyes to some issues that they are facing, and one thing I see many residents go through is the pain of menopause as well as the pains of old age. But we all see menopause in our own way in our own lives. My mother for example had an awful time with her change of life. The aches and pains of my aunts and fathers coworkers never fell upon deaf or unsympathetic ears. That’s why a statistic in our notes stood out to me even though it’s a very helpful hormone therapy is still unthought of as a successful treatment. 40% of woman in the US were using hormone therapy in 2002 and that it was only 20% a decade later. I believe that modern ideas and uses of HT can be more of a pro then a con to the menopausal women of today. Just due to the modernization and innovations in the field must have led to a safer method to deliver hormone therapy. Let alone cut out some of the risks associated with using HT in menopausal women.

Who should consider hormone therapy as an option? What makes a good candidate for HT other than being a menopausal woman? Well usually women presenting with mild to moderate symptoms that are well controlled should not seek out HT. Usually it should be reserved for those experience severe menopausal symptoms, who either cannot tolerate or are not benefiting from other treatments. But also, women who are experiencing premature menopause or those who have lost functionality of their ovaries. And in that later category that go untreated are at higher risk of early death, Parkinson’s like symptoms, anxiety, and depression. There are some that should avoid HT people who have had previous cancers, blood clots, liver disease or unexplained vaginal bleeding. As HT could worsen these symptoms and possibly recurrence of the previous cancer. But the pros are the alleviation of the symptoms in many cases. And mainly this is a thing for woman in western cultures like in japan shoulder stiffness becomes a symptom of menopause not commonly mentioned in the west. But many other cultures experience far lessened symptoms and some point to the rise of youth culture in the us.

When we look at HT there are several different medications, but the treatments are mainly ET (estrogen only therapy) usually prescribed to women who have had a hysterectomy thus having no uterus. And EPT (Estrogen + Progestogen Therapy) the addition of progestogen helps to protect against endometrial cancer from estrogen alone. The Idea now is to minimize any cancer risk by doing the lowest effective dose for the shortest time period thus severing the risks of cancer. Hormone regimens now are low doses of estrogen for 15 days, followed by ten days of progestogen and then nothing for the last five. This is quite like the system that birth control pills employ to prevent pregnancy. Any real concern that comes with HT is the dosage and the period of time it is being used, high does over a long drawn out period is obviously going to carry more risks.

But how does HT really help with menopause? It makes up for the normal loss of estrogen that comes with aging. But it also alleviates the symptoms of menopause like osteoporosis, stroke, heart disease, and colon cancer. Studies show it effectively helps reduce instances of hot flashes, vaginal dryness, night sweats, and bone loss. Still there are some negative side effects associated with HT, any hormone therapy including birth control. There are always risks such as blood clots and pulmonary embolism. But the risks are upped as well as some that only appear with EPT. With the addition of progesterone some patients react adversely to the synthetic hormone addition. The reactions they experience bloating, depression, and irritability. This is one of a myriad of reasons people abandon hormone therapy. But there are several options on the market that are effective in some cases but do not affect estrogen levels in the body. Clonidine which can reduce the instances of hot flashes and night sweats, but research shows while it doesn’t carry the cancer risks of HRT, it isn’t as effective as HRT and carries some side effects like dry mouth and constipation. Bio-natural alternatives also are available, but many of these go unregulated and like any natural treatments there is no basis to say they are any safe or more effective than HT.

Looking back historically HRT was first available in the 1940s as a cure all for women’s troubles, but only gained popularity in 1960’s and 70’s. In that day and age menopause was also called “estrogen deficiency disease”. It wasn’t until 1976 that the treatment first found some trouble a study linked the treatment with endometrial cancer or at least the rise in the risk of getting endometrial cancer. But this same study also found that it lowered risks of heart disease. So even by this time when the treatment was already 30 years old we were still learning about the side effects. But this study did lower the treatment rates going from 28 million prescriptions to 14 million prescriptions in 1980. But the popularity of this treatment resurged in the 1980s. This was due to yet another study finding that the treatment helped with bone thinning. And by 1992 non-contraceptive estrogen was the most widely prescribed drug in America. Also since this time new drugs and combinations of treatments have become available. Alternatives to HRT have also found to be effective. Things like getting regular exercise and eating a proper diet as well as quitting smoking and using personal lubricants for women experiencing vaginal dryness. These are simply some alternatives but still if these are not effective some would have to look for possibly a hormone-based treatment, if not another source for alleviation of symptoms.

In the last paragraph I discussed the studies that either condemned or praised here I’ll go in a little more depth on those studies. Several studies have been performed trying to look at any probable links between a disease and HT. One example and probably the most famous is The Million Woman study in the UK which enrolled one million women ages fifty and older to study the effects related to HRT use and the large number meant a broader range of health questions and concerns could be addressed. The results from this study in terms of endometrial cancer showed that women using HT in the estrogen + progesterone variety are twice as likely to have instances of breast cancer. Estrogen only users have only a one-point three percent chance. The study also showed the increase of other risks and but again these are already known. Another study looking at the effects of HT on osteoporosis found that while it reduces vertebral damage and hip fractures only a limited number of studies with fracture outcomes have been publishes. In relation to heart disease we have records of at least 30 studies that have suggested that estrogen lowers bad cholesterol but as one study showed the risk of heart disease increases and then decreases within a year of continued treatment. But not all the results have been negative studies do show a lower risk and occurrence of colon cancer. Also, women on HT preserve or improve cognition then women of the same age not undergoing treatment. This again only states a previously made point, that only in extreme cases should HT be used and only when the risks presented are worth the reward, and when all other options have been exhausted or proved ineffective.

In conclusion I will admit my hypothesis was wrong, I no longer believe that HT should be widely used by women. I instead find myself agreeing that it should be looked at on a case by case basis. And that only the most extreme cases should have the treatment, and that people like me who have a family history of cancer and heart disease would not benefit from hormone replacement therapies. And that the sheer risks of cancer, and other possible side effects render this beneficial but all too risky. I found in one article a quote from a Dr. Lobo of the University of Southern California School of Medicine who was a co-chairman of the international conference on HRT. When asked if it was unnatural to try to control the occurrence of menopause it’s quoted that he said “Some women will consider it unnatural to alter body chemistry. Neither is it natural from an evolutionary standpoint for a woman to live into their 80s.” All and all we face an issue with the fact that all these studies and findings cause a certain amount of uncertainty about the effectiveness of these drugs, but as I mentioned before there are alternatives to HRT in menopausal women. But this is like the issue in 1987 with the “mammogram saves lives” campaign. In 1987 the national cancer institute recommended that woman at age 40 should start having mammograms every year or two. The American Cancer Association got behind the idea of early screenings and backed the campaign. But in 1993 the recommendation was changed because the importance of screening that exact age group came into question. In 1997 a panel began looking into the mammogram issue and after six weeks they found no basis for all women in their forties to have regular screenings. Another instance of a possibly beneficial treatment for some but possibly damaging for others.