Let’s talk menopause. Some people think of it as a disease. However, it is a natural consequence of aging. Many make the assumption that we know all there is to know when it comes to treatment. However, it is a relatively new phenomenon. Think about it. In 1900 the average life expectancy for women was 43 years. Menopause has only been something we have had to deal with for three generations. My grandmother was born in 1900 so she was amongst the first to make it beyond menopause, then there is my mother and myself following in suit.

In the past, those suffering from hot flashes, fatigue and mood swings were started on Premarin and Provera. Premarin is made from pregnant mare urine and Provera is a synthetic progestin not to be confused with natural progesterone. Most women were kept on these hormones and common medical opinion was that they prevented osteoporosis and heart disease.

All that changed in 2002 when the results of the Women’s Health Initiative study were released and the study was stopped because it was found that the risks of these particular hormones outweighed the benefits. Instead of putting almost every menopausal woman on hormone replacement, the majority of women were not started on them, were pulled off of them, or stopped them on their own.

Needless to say there were and are a lot of hot women running around who are a little testy because they are not sleeping and are sick of having to deal with their menopausal symptoms. Let’s talk about the study and what was found and who was studied. Then we can talk about alternative hormone therapy.

The study (started in 1997) involved over 16,000 women who were on average 63 years old, had a uterus and had never had a hot flash. They were either treated with Premarin (0.625 mgs) and Provera (2.5 mgs) or a placebo. Over 10,000 women who had a hysterectomy were either treated with Premarin alone or placebo. Many women in both groups had high blood pressure and high cholesterol that was being adequately treated.

The study was stopped early when it was found that those on combination hormones were more likely to have a stroke, heart attack and breast cancer than those on placebo. In those treated with Premarin alone there was no increased risk for breast cancer or heart attack but a slight increased risk of stroke.

Younger women (ages 50-59) who were treated within 10 years of going through menopause had a slightly decreased risk for developing heart disease. Women over 65 who were treated had an increased risk of developing dementia.

Here are some things to consider. When one looks at the group treated with Premarin alone, there were fewer associated risks. Provera seems to be the more dangerous medication when it comes to heart attack and breast cancer risk. In addition, most physicians would not start a 63-year-old woman with high cholesterol and high blood pressure on high dose hormones. The reason being that we know that hormones can increase the risk of clotting which would potentially precipitate a heart attack and stroke. Perhaps the increase in dementia was due to this as well.

I think it is important to know what the decision to stop hormones was all about. Knowing this, you can decide for yourself if hormone replacement is for you. To do that you need to know what else is out there. Premarin and Provera are rarely prescribed anymore. There are newer options called bioidentical hormones. These hormones are recognized as natural hormones by the body. Are they for you? Stay tuned!

More on these options in the next blog.