How has the thinking on hormone therapy evolved over the past 20 years. What are the latest findings on hormone therapy safety and efficacy. Why are experts advocating for increased awareness about menopause treatments. How can women access expert care for menopause symptoms.

The Evolution of Hormone Therapy Research: From WHI to Present Day

The landscape of hormone therapy (HRT) for menopausal women has undergone a significant transformation over the past two decades. In 2002, the Women’s Health Initiative (WHI) study sent shockwaves through the medical community when it reported increased risks of breast cancer, heart attacks, stroke, and blood clots in women taking a combination of estrogen and progestin. This led to a dramatic 80% decrease in hormone therapy use in the United States.

However, subsequent analyses of the WHI data have painted a more nuanced picture. What did researchers discover upon closer examination? They found that the risks were primarily associated with older women, while the benefits of hormone therapy generally outweighed the risks for healthy women under 60 years old and within ten years of menopause onset.

Long-Term Follow-Up Studies: Reassuring Results

An 18-year follow-up study of WHI participants has provided further reassurance regarding the safety of hormone therapy. The study, published in JAMA, revealed that women who took hormones for five to seven years did not have a higher mortality risk in the subsequent 18 years compared to those who did not use hormone therapy. This applied to all-cause mortality, cardiovascular mortality, and cancer mortality.

Furthermore, observational studies focusing on women who initiate hormone therapy in early menopause have generally demonstrated lower mortality rates among users compared to non-users. These findings highlight the importance of timing and individualized approach when considering hormone therapy.

Dispelling Myths and Misconceptions: The Need for Updated Information

Despite the evolving research and updated guidelines, many women and healthcare providers remain hesitant about hormone therapy, often relying on outdated information from the initial WHI study. This knowledge gap has led to a situation where many menopausal women are not receiving potentially beneficial treatment options.

Expert Voices Advocating for Awareness

Several experts are working to bridge this information gap and promote a more nuanced understanding of hormone therapy. Oncologist Avrum Bluming and social psychologist Carol Tavris co-authored the book “Estrogen Matters” to address misconceptions surrounding hormone therapy. Their goal is to educate both women and medical professionals about the symptoms and medical implications of menopause, with a particular focus on the role of estrogen in alleviating symptoms and potentially prolonging women’s lives.

Innovative Approaches to Menopause Care: Telehealth and Expert Access

Recognizing the need for improved access to menopause care and expert guidance, new initiatives are emerging in the healthcare landscape. One such example is Evernow, a telehealth company founded by Alicia Jackson that specializes in menopause care.

The Rise of Telehealth for Menopause Management

Evernow aims to provide women with easy access to doctors who are experts in menopause. Through virtual consultations, women can discuss their symptoms, explore treatment options, and, if appropriate, receive hormone therapy prescriptions. This approach addresses several barriers to care, including the shortage of menopause specialists and the hesitancy of some general practitioners to prescribe hormone therapy.

Celebrity Backing and Awareness Campaigns

The importance of menopause care has gained recognition from high-profile individuals as well. Evernow recently secured over $28 million in investment, with celebrities such as Gwyneth Paltrow, Cameron Diaz, and Drew Barrymore serving as angel investors. Their involvement goes beyond financial support; these celebrities are committed to raising awareness about menopause, its symptoms, and potential treatments like hormone therapy.

Understanding the Impact of Menopause Symptoms on Women’s Lives

Menopause symptoms are not merely uncomfortable; they can have far-reaching effects on a woman’s overall well-being. How do these symptoms impact various aspects of life?

• Health: Hot flashes, night sweats, and sleep disturbances can affect physical health and increase the risk of certain conditions.
• Relationships: Mood swings, decreased libido, and vaginal dryness can strain personal and intimate relationships.
• Career: Cognitive changes, often referred to as “brain fog,” and fatigue can impact work performance and career progression.
• Quality of life: The cumulative effect of these symptoms can significantly diminish overall quality of life and well-being.

Given these wide-ranging impacts, it becomes clear why effective management of menopause symptoms is crucial for many women. Hormone therapy, when appropriately prescribed, can address many of these issues and improve quality of life.

The Importance of Individualized Care in Menopause Management

As our understanding of hormone therapy and menopause management evolves, the importance of individualized care becomes increasingly apparent. Why is a one-size-fits-all approach inadequate for menopause treatment?

1. Varying symptom profiles: Women experience menopause differently, with some having severe symptoms while others have mild or no symptoms.
2. Medical history: Individual health backgrounds, including family history and personal risk factors, play a crucial role in determining the appropriateness of hormone therapy.
3. Age and time since menopause onset: The benefits and risks of hormone therapy can vary depending on a woman’s age and how long it has been since her last menstrual period.
4. Personal preferences: Some women may prefer non-hormonal treatments or lifestyle modifications over hormone therapy.

Healthcare providers specializing in menopause care are equipped to consider these factors and work with patients to develop personalized treatment plans. This approach ensures that women receive care tailored to their specific needs and circumstances.

Empowering Women: Becoming the CEO of Your Health

Alicia Jackson, founder of Evernow, emphasizes the importance of women taking charge of their health care, particularly when it comes to menopause management. What does it mean to be the “CEO of your own health care”?

• Seeking out true experts: Look for healthcare providers who specialize in menopause and stay up-to-date with the latest research.
• Partnering with your provider: Engage in open dialogue with your healthcare provider, asking questions and expressing your concerns.
• Educating yourself: Stay informed about menopause, its symptoms, and treatment options through reputable sources.
• Advocating for your needs: If you feel your concerns are not being adequately addressed, don’t hesitate to seek a second opinion or explore other options.

By taking an active role in their health care decisions, women can ensure they receive the most appropriate and effective treatments for their menopause symptoms.

The Role of Lifestyle Factors in Menopause Management

While hormone therapy can be an effective treatment for many women, it’s important to consider the role of lifestyle factors in managing menopause symptoms. What lifestyle modifications can complement or, in some cases, serve as alternatives to hormone therapy?

Diet and Nutrition

A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help alleviate some menopause symptoms. Certain foods and supplements may be particularly beneficial:

• Phytoestrogens: Found in soy products, flaxseeds, and some other plants, these compounds may help reduce hot flashes for some women.
• Calcium and Vitamin D: Essential for maintaining bone health, which becomes increasingly important after menopause.
• Omega-3 fatty acids: May help improve mood and reduce inflammation.

Exercise and Physical Activity

Regular exercise offers numerous benefits for menopausal women:

• Weight management: Helps counteract the tendency for weight gain during menopause.
• Mood improvement: Can help alleviate symptoms of depression and anxiety.
• Bone health: Weight-bearing exercises help maintain bone density.
• Sleep quality: Regular physical activity can improve sleep patterns.

Stress Management

Stress can exacerbate menopause symptoms. Effective stress management techniques include:

• Mindfulness meditation
• Yoga
• Deep breathing exercises
• Regular relaxation practices

These lifestyle factors can play a significant role in managing menopause symptoms and improving overall health. When combined with appropriate medical treatments, they can contribute to a more comfortable and healthier menopause transition.

The Future of Menopause Care: Emerging Trends and Research

As our understanding of menopause and hormone therapy continues to evolve, what emerging trends and areas of research are shaping the future of menopause care?

Personalized Medicine

Advancements in genetic testing and biomarker analysis are paving the way for more personalized approaches to menopause management. This could lead to more precise prescribing of hormone therapy and other treatments based on individual genetic profiles and risk factors.

Non-Hormonal Treatments

Research into non-hormonal treatments for menopause symptoms is ongoing. These may include:

• New classes of drugs targeting specific menopause symptoms
• Advanced herbal and natural remedies
• Novel therapies for vaginal health and sexual function

Technological Innovations

Technology is playing an increasingly important role in menopause care:

• Wearable devices for symptom tracking and management
• AI-powered apps for personalized advice and treatment recommendations
• Telemedicine platforms specializing in menopause care

Long-Term Health Implications

Ongoing research is focused on understanding the long-term health implications of menopause and hormone therapy, including:

• Cardiovascular health
• Cognitive function and dementia risk
• Bone health and osteoporosis prevention
• Cancer risk and prevention

As these areas of research progress, they promise to further refine our approach to menopause care, offering women more effective, personalized, and comprehensive treatment options.

The field of menopause care and hormone therapy has come a long way since the initial WHI study findings. Today, with a more nuanced understanding of the benefits and risks, healthcare providers can offer personalized approaches to menopause management. As awareness grows and access to specialized care improves, more women can benefit from appropriate treatments, including hormone therapy when suitable. By staying informed, seeking expert care, and taking an active role in their health decisions, women can navigate the menopause transition more comfortably and maintain their overall health and well-being.

Here’s The Current Thinking On Hormone Therapy (It’s Not What You Heard 20 Years Ago)

Many doctors don’t discuss the option of hormone therapy with menopausal patients.

getty

Menopause symptoms aren’t only uncomfortable, but they can also impact a woman’s health, relationships and career. Although hormone therapy can reduce or eliminate menopause symptoms, most menopausal women don’t take advantage of hormones because of a decades-old study that warned of serious health risks. Although the thinking on hormones has changed, some women remain confused and afraid, and some medical doctors refuse to prescribe hormones. Now, the CEO of a telehealth startup, celebrities, medical doctors and others are trying to raise awareness about how the thinking on hormone therapy has evolved over the last twenty years.

Oncologist Avrum Bluming and social psychologist Carol Tavris are among those trying to raise awareness. They wrote amazon.com/Estrogen-Matters-Hormones-Menopause-Well-Being-ebook/dp/B078W61N8Z/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr=”>Estrogen Matters to clarify some of the misunderstandings surrounding hormone therapy. “Our goal in writing the book and subsequently answering the dozens of emails we receive from women around the world is to educate women and the medical profession about the symptoms and medical ramifications of the menopause—and, in particular, the role of estrogen in ameliorating symptoms and prolonging women’s lives,” Bluming says.

Alicia Jackson, Evernow founder and CEO, also wants to help alleviate the confusion surrounding hormone therapy and other treatments for menopause symptoms. She started the telehealth company which focuses on menopause care to provide women easy access to doctors who are experts on menopause. “I really want women to know that they need to be the CEO of their own health care. They should be seeking out practitioners who are true experts, who want to partner with them and give them the tools and the information that they need to make good decisions for their health,” Jackson explains. Evernow’s physicians can help women decide if hormones are the best choice for them, and, if appropriate, they can often be prescribed after a virtual visit.

In early April, Evernow received over $28 million in investment, and Gwyneth Paltrow, Cameron Diaz, Drew Barrymore and other celebrities are serving as angel investors. These celebrities invested in Evernow, not only to help the company reach more women but also because they are also committed to raising awareness about menopause, menopause symptoms and potential treatments like hormone therapy.

The Current Thinking On Hormone Therapy

The reason these individuals and others are making efforts to raise awareness regarding the current thinking on hormone therapy is that the current thinking is dramatically different than it was twenty years ago. Over twenty years ago, the Women’s Health Initiative (WHI) study, which randomized women to receive either hormone therapy or a placebo, set out to assess the benefits and risks of hormone therapy. In 2002, the WHI study was abruptly halted because the researchers found that women taking a combination of estrogen and progestin had an increased risk of breast cancer, heart attacks, stroke, and blood clots. Headlines blasted the news that hormone therapy was unsafe, and the use of hormone therapy in the United States plummeted by about 80%.

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Later analysis of the WHI study data focused on the age of the participants. This analysis found that primarily older women were at high risk from the use of these hormones, and that the benefits of hormone therapy generally outweighed the risks for healthy women who are under 60 years old and within ten years of the onset of menopause. Despite the good news, many women and doctors are still relying on the original warnings to guide their decisions regarding hormones.

An 18-year follow-up study of the participants in the WHI study provides more reassurance on the safety of hormones. The report found that women who took hormones did not have a greater chance of dying in the subsequent 18 years than those who did not. The researchers report in JAMA that hormone therapy use (estrogen alone or estrogen plus progestin) for five to seven years “was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years.”

In the same article, the authors conclude, “Observational studies, which include primarily women who initiate hormone therapy in early menopause, have generally demonstrated lower mortality among women using hormone therapy compared with nonusers.” In other words, according to these studies, women who started hormone therapy in early menopause tended to live longer than women who didn’t take hormones.

In fact, a pooled statistical analysis of thirty clinical trials found that women who began hormone therapy before age 60 had a 39% lower risk of death than women who didn’t take hormones.

With all of this new information, why is there still so much resistance surrounding hormone therapy? JoAnn Manson, a Harvard Medical School professor at Brigham and Women’s Hospital and one of the lead researchers on the WHI study, says it’s been difficult to get the word out about follow-up studies showing that benefits outweigh risks for younger women with menopause symptoms.

“There were all these alarm bells that went off in 2002. And once a bell is rung, it cannot be unrung,” Manson explains. “It’s taking a very long time to make it clear that there were differences by age and that hormone therapy is still an appropriate treatment for women in early menopause who have moderate to severe symptoms. The results are all out there in prominent journals read by clinicians,” she says.

Newer formulations of hormones, not widely used when the WHI study began, may further minimize risks. Manson says that preliminary data from studies examining these newer hormone formulations including transdermal estrogen (delivered through the skin via a patch) and micronized progesterone are promising. Transdermal estrogen doesn’t go through the liver and may also reduce the chances of blood clots and stroke compared to oral estrogen. And Bluming and Tavris write, “When women take estrogen combined with natural, micronized progesterone, no increased risk of breast cancer has thus far been observed in any study. ”

Although some of these new FDA-approved formulations are promising, all of the experts I spoke to caution against the use of compounded hormones. Compounded hormones are not regulated by the Food and Drug Administration (FDA), and these compounds have not been shown to be safe or effective and can have impurities and inconsistent dosing. As evidence of the lack of reliable information available to women, 35% of women currently on hormone therapy take these unregulated compounds. How do you know if your hormones are compounded? If the hormones are produced by a pharmaceutical company that is recognized and approved by the FDA, then they are not compounded.

Another concern for those considering hormone therapy is the risk of dementia. In her book, XX Brain, Lisa Mosconi, director of the Women’s Brain Initiative and associate director of the Alzheimer’s Prevention Clinic weill.cornell.edu/clinical-services/alzheimers-disease-memory-disorders-program/alzheimers-prevention-clinic”> at Weill Cornell Medical College, points out that brain imaging studies suggest that the decrease of estrogen at menopause likely plays a role in explaining why women have a greater risk than men for Alzheimer’s. But that doesn’t necessarily mean that hormone therapy reduces that risk for all women. Mosconi writes that there is some evidence that for younger women who begin hormone therapy within five years of menopause, these hormones may be helpful in fighting off cognitive decline. However, in women older than 60 years, or more than five years past menopause, there is some evidence that hormone therapy may increase the risk of dementia. Also, for those women already showing early signs of dementia, hormones likely won’t help and could make things worse. More research is clearly needed in this area to determine how to best use hormones to ward off dementia.

For women with menopause symptoms who are not good candidates for hormone therapy or who are reluctant to take hormones, there are other potential remedies. For example, Evernow also offers SSRIs as an option. SSRIs, typically prescribed as anti-depressants, have been shown to relieve hot flashes and other menopausal symptoms.

Menopause Symptoms Impact Health And Work

Menopause symptoms aren’t limited to hot flashes and night sweats. Other symptoms of menopause include difficulty sleeping, difficulty concentrating, mood swings, depression, headaches, racing heart, vaginal dryness, decreased recent memory and decreased energy. For some women, these symptoms begin years before menopause.

Hot flashes are uncomfortable, but they are also related to other issues. Hot flashes can disrupt sleep and may cause mood changes, difficulty concentrating, and impairment of short-term memory. In one study, frequent hot flashes and night sweats were associated with a 50% increased risk of cardiovascular disease. And, if these hot flashes and night sweats persisted over time, then there was a 77% increased risk of later cardiovascular disease.

Menopause symptoms can also impact relationships and careers. The British Medical Association surveyed female doctors of menopause age and found that “a significant number have reduced their hours, left management roles or intend to leave medicine altogether, despite enjoying their careers, because of the difficulties they faced when going through menopause.” Over a third (36%) of the doctors surveyed had made changes to their working lives due to menopause, and an additional 9% intended to make changes. Another study found that about a third of working, post-menopausal women report that their job performance was negatively impacted by symptoms of menopause, and yet another found a startling 83% of respondents who had experienced menopause said it negatively affected their work.

Given the health and career impact of menopause symptoms, it’s a problem that many clinicians are not well-informed on the current thinking regarding hormone therapy. Bluming explains that part of the problem stems from the fact that menopause education is currently offered to less than 25% of residents studying obstetrics/gynecology. This may also explain why some practitioners still refuse to prescribe hormones. Given that over 50 million women in the United States are over the average age of menopause (51 years), one would think menopause care would be a higher priority.

Each woman has unique needs and finding a knowledgeable healthcare professional is key to figuring out what’s best for her health. For those women who have doctors that are not trained in menopause treatments or refuse to discuss hormone therapy, there are still options. These women can either take the telehealth route and speak to trained professionals virtually, or they can access the North American Menopause Society (NAMS) web page to find a NAMS Certified Menopause Practitioner in their area.

HRT opened my eyes, and gave me my life back | Mariella Frostrup

Addressing a professional women’s networking event recently, it only took one word to reduce the excitable and cocktail-lubricated room to silence. The lethal word I dropped was “menopause”; controversially referring to a sorority of which many in the room were reluctant members.

The word menopause must rank as one of the most feared in the English language, whispered only behind closed doors to trusted companions, preferably medically trained, and conjuring visions of sweat-soaked sheets and tragic attempts to appear youthful.

Thanks to its end-of-life imagery and the terror women display in admitting they’re in its grip, it has more in common with a virulent disease than the mere resetting of our biological clock.

Thankfully perceptions about this chapter in the female life cycle may finally be changing. Nice has this week announced new guidelines for diagnosing and dealing with menopause. I say “new”, but it’s the body’s debut on the topic; indicative of the web of silence woven around this unavoidable occurrence in what is now merely mid-life. Women have been coping with the manifestations of menopause – mental and physical – since time immemorial, so while I applaud the guidelines “to stop women suffering in silence”, their focus is long overdue.

The menopause has a serious image problem and has been judged a shameful, guilty secret for sufferers amid a prevailing culture of disparagement and ignorance. The guidelines simply lay out what most women post-50 already know, that establishing our reproductive tipping point is a guessing game with little tangible diagnostic help on offer, the symptoms are far ranging and unique to each individual, and progress in treatment for these reliant on the NHS has remained stagnant for nearly 30 years.

Thirty years later, I’m still sticking on the same HRT patches my mother tried and rejected as making her feel “bovine”. Controversially, as I discovered when I made my first claim, those with private health insurance policies are generally not covered at all. As astonishing is the fact that most women like me, clued up and capable in so many areas of our lives, stumble blindly into our second most hormonally disruptive stage next to puberty. Studies on teenage turbulence are ten a penny, but establishing the menopause as territory that requires specialised support from medical experts and cognitive therapists has only now, thanks to Nice, been placed on the public agenda.

I’m one of the many who have stumbled across their declining fertility entirely by accident, despite considering myself a reasonably well-informed, mature woman. Two years of sleepless nights, unfounded anxiety attacks and a very short fuse with friends and family finally led me to a female gynecologist.

Establishing the menopause as territory requiring specialised support has only now been placed on the public agenda

When you’re feeling below par, confronting a contemporary looking like an extra from a Robert Palmer video in a figure-hugging black dress might be offputting; particularly when she’s waving a speculum at you. Instead she impressed further by diagnosing my symptoms while offering compelling proof that the future wasn’t sexless, dressed in twinsets and sensible shoes.

“You’re mid-menopause but you don’t need to suffer like this,” she insisted, living proof that perhaps I didn’t. She wrote out a prescription for HRT, testosterone, melatonin and the hormone DHEA, all of which would make life more bearable, and booked me back in six months. Unusually I was speechless, still recovering from my ignorance that anxiety rather than hot flushes could be a menopausal symptom.

I’d had reservations regarding HRT, having read plenty about its link to the increased risk of breast cancer. Although Nice confirms that link, it also suggests that the risks are less onerous than previously thought and that with proper monitoring they can be minimised.

After 2,000 years of female suffering you’d imagine we would have reached acceptable monitoring levels by now. A month after leaving the surgery I was a new woman, or returned to my old self at least. Melatonin had helped me to reset my sleep patterns, testosterone had given me renewed vigour, and HRT seemed to have levelled out the mood swings from fury to low-level depression and put me back on a more even emotional keel.

If we were all to receive better, more up-to-date and informed guidance instead of snarling at the world and losing catastrophic levels of self-confidence, while facing alone an exhaustive list of baffling symptoms – from the aforementioned insomnia and anxiety, to loss of libido, panic attacks, hair loss, sagging skin, exhaustion, weight gain, weight loss and hot flushes – we’d be in a position to manage the changes we were undergoing. In an age when medical science can work biblical-style miracles, helping paralysed men walk, there’s not a woman I know who hasn’t felt ambushed by this physical inevitability up there with puberty and death.

Since first airing the M-word in public I’ve been designated a “pioneer”, frequently dragged into corners by total strangers confessing a variety of symptoms they fear mark the beginning of the end. One told me she failed to consult her gynecologist about her symptoms for three years because he was quite cute and she didn’t want to admit she was “dried up and finished”.

The only shameful thing is that women today are still stumbling into the closing cycle of their reproductive days in blind ignorance because of the shroud of secrecy and shame that envelops this natural part of our life cycle. Hopefully the Nice guidelines adjust perceptions, bringing hot flushes and the accompanying symptoms in from the cultural cold and ending the tyranny of silence that’s inflicted on mortified, menopausal women. Instead of creeping up on you like a mugger in a dark alley, the menopause can finally step out of the shadows to be anticipated, understood and planned for.

My baby-making days may be over but once you’ve negotiated the hormonal depths, equilibrium happily returns. For what you lose, which in the end is just a bothersome monthly inconvenience if your child-bearing dreams are done with, there is also much to be gained.

Renewed confidence is the greatest gift, allowing you to find peace in your own company; to wear what you like rather than let the vagaries of fashion dictate; to enjoy more intimate and honest relationships with your friends; and to find laughter and wisdom where others see only the tragedy of leaving youth behind. I know better nowadays how to wring every last moment of pleasure from each breathing moment and intend to keep doing so, as healthily and heartily as possible, for as many more decades as my beating heart allows.

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Snowmobiling

HRT Snowmobile Suit

Hrt

HRT is a young but promising Russian brand owned by the famous Bask company.

Under this brand, a collection of clothing and textile accessories has entered the market, creating maximum comfort for professional hunters and fishermen. The key differences between the products of this brand and the model range of the parent company are that the product models are designed to be worn in the temperature conditions of the middle and polar geographic zones.

The cooperation of the company’s management with competent clothing designers made it possible to create accessories, the high comfort of which does not affect reliability in any way, thanks to which the brand’s products are in demand.

Each item is designed with specific use in mind. The founders of this brand set strict requirements for quality standards. Therefore, the most modern materials (fabrics and accessories) are used for production, the declared characteristics of which are confirmed by the relevant certificates.

Functionality, quality and wear resistance of each product are mandatory tested before the line is put into mass production. This procedure is established by the parent company Bask, which has a special production workshop in which new samples are sewn, then all things are tested and, if necessary, finalized. This algorithm predates the launch of HRT branded production model lines.

Despite its young age, the HRT brand has successfully taken a leading position in its segment of the outdoor accessories market, thanks to a competent production and marketing policy.

The company’s management has chosen a course for the maximum use of modern innovative technologies. In production, the latest technological solutions are used, which, together with innovative materials, ensure the maximum quality of products. Therefore, in clothes from HRT it is impossible to freeze, as well as overheat.

HRT currently produces a wide range of all-season men’s and women’s clothing. The position of the brand is growing and strengthening thanks to Bask’s many years of experience in designing reliable clothing for extreme conditions.