Menopause: Where Are We Going with Hormone Replacement Therapy?

For some women, menopausal symptoms can be very difficult to manage even with modification of lifestyle. The desire to replace this hormonal deficiency with some exogenous hormones remains strong. The use of these exogenous hormones such as estrogen began as early as the 1950’s and have increased steadily ever since. In the late 1970’s, the risk of developing endometrial cancer was discovered, resulting in additions of progesterone. Since 1980, the use of a combination of estrogen and progesterone has dominated most of the hormonal replacement regimen. Most studies in the 1970’s have shown benefits of using estrogen alone. With the change to combined use, interpretations of the evidence became murky at best and confusing since whatever the effects of estrogen or progesterone have on menopause will differ. As time elapsed, increasing risks of using combined therapy began to gradually surface until 2002. The evidence of increased risks of breast cancer, coronary heart disease, stroke, and venous thromboembolism from a randomized trial called The Women’s Health Initiative (WHI) was reported in the July 2002 issue of the Journal of the American Medical Association. There were several arms to this trial. The trial of combined therapy of using both estrogen and progesterone, specifically Prempro (Wyeth Ayerst) containing conjugated equine estrogen (CEE), 0.625 mg, and medroxyprogesterone acetate (MPA), 2.5 mg was stopped early. There were 16,608 women with an average duration of 5.2 years of usage in which 50% of the population was randomized to placebo. The unopposed estrogen only arm was recommended to continue and will be reassessed in 2005. The result of combined estrogen and progesterone trial showed that breast cancer risk increased by 24%, while the risk of stroke increased by 31%. In the August 2003 issue of the New England Journal of Medicine, WHI published the final coronary heart disease results for the combined therapy arm showing a 24% overall increase in the risk of coronary heart disease (CHD) and an 81% increased risk of CHD in the first year after starting the Estrogen plus progesterone combined therapy. On the positive sides of the studies, overall bone fractures were decreased by 24% ,while hip fractures were reduced by 33%. The endometrial cancer rate was also reduced by 19%.

Women’s Health Initiative

Findings Summary

Breast Cancer                              24% Increase

Endometrial Cancer                 19% Decrease

Ovarian Cancer                           58% Increase

Colorectal                                     CancerDecrease

Coronary heart disease          24% Increase

Stroke                                             31% Increase

Blood Clots                                  Increase

All fractures                                24% Reduction

Hip fractures                               33% Reduction

Cognitive functions                  No change – does not protect

Quality of life                               No clear benefit

The risk is simply too great for using combined therapy without any symptomatic reasons. Even with severe symptoms of menopause, many women have chosen to tolerate the symptoms and avoid hormones all together. But the symptoms of menopause such as hot flashes, disturbed sleep, moodiness, fatigue, loss of mental clarity, vaginal dryness, decreased libido and many others can be debilitating and difficult to ignore. Many women have come to Tao of Wellness seeking an alternative assistance with their conditions.

When we see you for the first time in dealing with your perimenopausal symptoms, it is frequently not simply addressing symptoms of menopause. Many of the perimenopausal women have menstrual irregularities, uterine fibroids or other issues that can respond poorly to any direct hormonal interventions. Our approach to your condition comes from the conception of total wellness where we take into considerations four main aspects of your body and spirit – genetic tendencies, current health status, lifestyle issues, and finally the important symptoms. Our goals are not merely helping you in dealing with these symptoms but also to encourage wellness and to slow down the aging process. Our advice frequently will include lifestyle modification, dietary guidance, and Chinese Medicine therapies. All advice are tailored to your specific needs and conditions. Most of the time, no two patients will receive the exact acupuncture and herbal therapies. The key to a smooth menopausal transition is to become more aware of your body, especially with subtle changes and take care of them before the symptoms turn severe.

Many women begin their journey toward menopause long before they reach 50. Some women can experience some of the symptoms of perimenopause as early as their forties. These symptoms can be warm flashes, menstrual irregularity, weight gain, hair loss, dry skin, decreased libido, increasing fatigue, increasingly disturbed sleep, increased body hair, increased premenstrual tension such as moodiness, breast tenderness, and constipation. By addressing these symptoms early on, you can balance your body’s endocrine system and prevent major health issues associated with menopause. If you answer yes to any of the following questions, you should consult one of our wellness practitioners.

• Are you experiencing increasingly shorter menstrual cycles?
• Are you feeling warmer at times especially during your sleep?
• Are you finding your sleep becoming more restless and light?
• Are you finding yourself more moody overall without any specific cause?
• Are you having increasingly difficult time in losing weight?
• Are you having increasingly tender and enlarged breasts premenstrually?

If you answer yes to any one of the above questions, you may have the onset of perimenopausal symptoms. When the symptoms are discovered and treated earlier, they are much easier to manage. There are also many things you can do to improve these symptoms by examining areas of exercise activities, dietary intake, sleep patterns, and regular stress levels. Normally one should incorporate a variety of cross training exercises such as passive strengthening, aerobic exercises and meditative exercises. These would include walking, hiking, gentle weight lifting, yoga, Tai Ji Chuan, Qi Gong, jogging, and many other activities. The key is to alternate them and not to just do one form of exercise. Dietary intake should be regular and rich in fiber, greens, and fruits. Moderation is the key to a good balanced diet. The intake of alcohol, sweets, and caffeine should be limited and moderate. A good sleep is paramount to high functioning in the day as well as reduced perimenopausal symptoms. Try to wind down your clock after sundown by engaging in relaxing and soothing activities. Going to sleep before 10 and getting up at 6 is an ideal pattern for most people. Lastly, monitor your stress level, you will find that during the perimenopausal time, your stress tolerance is lower and you may tend to be stressed out with things you normally would be fine with. Again, by having a better lifestyle and becoming more aware of your body, you can naturally adjust yourself to the stress level better. Writing journals and putting your emotions and thoughts on paper is also a very good way to put away stress.

Synthetic hormones are no longer the gold standard for menopausal treatment and there are many alternatives that can be as effective without all the risks associated with HRT. Traditional Chinese Medicine provides a viable safe approach to perimenopause and menopausal symptoms. At Tao of Wellness, we are honored to be able to help you and educate you on menopausal issues and work with you on having a smooth menopausal transition.