The cause, treatment, and treatment risks for (peri)menopause symptoms are better understood. Still, there are unanswered questions and residual confusion inspired by the WHI study.

The (peri) menopause debate is centuries old.
100 years ago ‘extreme nervousness’ was understood as an inevitable part of menopause. A period of complete reversal followed. Behavioral and mood symptoms during menopause were thought to arise from concurrent life stress and having the wrong attitude. With the availability of exogenous estrogen and progesterone, women with vasomotor symptoms were effectively treated with hormone therapy. The undeniable evidence that rates of heart disease rose after menopause led to the Women’s Health Initiative (WHI) study. This study explored the heart benefits of exogenous estrogen. This study for many reasons failed to show this benefit. So women and providers were discouraged from using hormone therapy for this purpose and sadly for any purpose. Hormone therapy was deemed unsafe. However, new studies showed that the type of hormone and the woman’s age mattered.

Weird is not just an American political term
We are currently in wired times. The extreme nervousness from 1887 has been replaced by constant anxiety and the fear of missing out (FOMO). The rise of social media and the number of women in the workforce amplified this shift. Now we assume (peri)menopause must be treated and that all negative changes during this period are attributable to hormonal changes.

Hormone profiling exists. For the right woman with the right indication, hormone therapy is safe and effective.
A menopausal woman, under the age of sixty, suffering from hot flashes and night sweats and without breast cancer may benefit from hormone therapy. It is less certain what the role of hormone therapy is for this same woman without menopausal symptoms. About thirty percent of women fall into this latter category.

The use of hormone therapy only for the prevention of chronic disease prevention is controversial
An analysis of the WHI study showed decreased breast cancer and heart disease in menopausal women under the age of 60 taking estrogen-only hormone therapy for the relief of menopausal symptoms. In the estrogen-progesterone group, there was a slight increase in heart disease and breast cancer. Only 10% of women have had a hysterectomy and as such may be treated with estrogen alone. Women with a uterus risk developing uterine cancer with estrogen therapy alone.

There are limited effective (peri) menopause symptom options for women with breast cancer.
There are few effective non-hormonal treatment options for a menopausal woman with hot flashes and also a history of breast cancer. About 10% of women will develop breast cancer. SSRI antidepressants, clonidine, and gabapentin have been prescribed. These are less effective and have more side effects than hormone therapy. The safety of the new non-hormonal medication Veoza, has not been studied in women with breast cancer.

Hair loss, joint pain, and rosacea are common menopausal symptoms that are resistant to hormone treatment.
The majority of menopausal women are negatively affected by one or more of these symptoms. These symptoms are concurrent and not hormone-causative. So the use of hormone therapy is not an effective treatment for these symptoms

Food for thought:
My metaphorical balloon was deflated when I was asked by a 22-year-old woman at the end of one of my menopause presentations- is there anything good about menopause? I admit nostalgia for the carefree ease of my 20s- free from family obligations and time limitations on my goals. Yet, I embrace watching my children grow into interesting young people and living confidently knowing what I am and what I am not.

Some have cited freedom from periods, gaining wisdom, and self-confidence as their menopause advantages. What menopause treats are you looking forward to?

Leading up to world menopause day, I’ll address the current attitudes and treatment of common mood and behavioral menopausal symptoms like brain fog, fatigue, and weight gain

Milie Nwoye MD
wwwenostrong.be
Feel yourself again.