PRESS PAUSE ON MENOPAUSE

Do you warn your menopause patients about the harms of hormone replacement therapy?

Click here for previous newsletters.

1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer 

3. Quick Wrap-up 

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: "My Doctor is refusing to prescribe hormones to treat my menopause because they say it's unsafe. Is that true?"

Concise Conclusion: Unfortunately, once information is updated, it can take decades to reach most Primary Care Providers. There was a study that came out in the early 2000's that seemed to suggest hormone therapy for menopause increased the risk of stroke and breast cancer. However, this study had many flaws, and it's now clear that, overall, the benefits (which extend beyond menopause symptom relief, for example improvements in bone health) outweigh the risks. In fact, subsequent studies even showed that there is harm in having sustained low estrogen levels such as the process that takes place in menopause and therefore for overall good heart health it is actually protective to use hormone therapy to treat your symptoms; the very opposite of what that flawed study had wrongly claimed. I can send a fax to your doctor with this information to advocate for you, or you may need to seek a second opinion, which may be difficult to get especially in Canada.

Quick Wrap-up: Here are some quick pearls on the shortcomings of the WHI study and its conclusions, which may prompt the FDA to remove the black box warning on it in the USA:

-it did not show increased breast cancer deaths (which you'd expect if it was really increasing breast cancer rates). Furthermore, this increase was due to unusually low rates of breast cancer who previously had been on HRT in the placebo group

-they used medroxyprogesterone (an outdated progestogen)

-they used an oral estrogen (non-oral estrogens have been shown to have lower risk of clotting)

-a 2015 Cochrane review showed lower CV risk if initiated within 10 years of menopause (though not if initiated after the 10 year window)

-bone benefits are clear (even within the WHI study)

Dive Deeper

1) WHI study: https://pubmed.ncbi.nlm.nih.gov/12117397/

2) Cochrane: you'll need to do some digging here, the conclusions don't give you this information https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000097/full

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