Over the past two decades, unclear and often misunderstood differences in the effects, both beneficial and adverse, of different hormones , combined with the fear of malpractice litigation have created the ‘perfect storm’ of negative information on menopausal hormone therapy. Yet if administered properly, hormonal treatment of menopause not only controls menopausal symptoms and delays aging but also prevents osteoporosis and fractures, colon cancer, cardiovascular disease, as well as Alzheimer’s and other degenerative diseases of the central nervous system.
There is no question that estrogen replacement in women after premenopausal hysterectomy and oophorectomy (removal of the ovaries) lowers the morbidity and mortality of all causes. The report in Lancet further indicates that it may even decrease the risk of breast cancer by about 20%. What about women going through natural menopause? As of yet, medicine does not have all the answers. However, there is strong evidence that the type of estrogen, the route of its administration, the combination with progestogens if any, and treatment delay after the onset of menopause, all affect the risk to benefit ratio of hormone replacement therapy. Hopefully, current recommendations of the medical profession “…that hormone treatment should only be used for menopausal symptoms such as hot flashes and night sweats…” and “…at the lowest dose…” and “…for the shortest period of time…” will be rapidly eliminated to the benefit of women who at this day and age outlive their ovaries and spend almost half of their lifetime after menopause. At that point, we are confident that the enormous benefit for improved quality of life, and the prevention of disabilities and chronic debilitating diseases, will become apparent.
There is no other endocrine deficiency in which patients are denied hormone treatment when the gland stops functioning. We must question why such recommendations do not apply to the treatment of menopause.