Hormone Therapy for Menopause and Perimenopause
By Francesca Coltrera
Your need-to-know guide to today's hormone therapy -- what's safe, what's new, what's right for you
Not long ago, a friend told me about a coffee date she’d had with a 50-something former office mate, Susan. As the two women were sipping their lattes and catching up on each other’s lives, Susan nervously glanced around the coffee shop, then leaned across the table and confided in a low voice, “I’m taking estrogen.”
So it’s come to this. Whereas women once chatted openly about their hormone-therapy regimens, they now confess their dependence on estrogen in a whisper, as though it were an illicit street drug. Chalk it up to the 2002 report from the Women’s Health Initiative, when researchers announced that the popular drug Prempro — a combination of estrogen and progestin — raised the risk of breast cancer, stroke, heart attack, and blood clots. The study was stopped, and millions of women threw away their hormones.
But then came what sounded like a reversal: In 2004, additional WHI data crunching showed that women taking estrogen alone were not more likely to develop breast cancer or have heart attacks (though the higher risks for strokes and blood clots still stood). And just last year, two studies on women in their 50s suggested that taking estrogen alone might actually protect middle-aged women’s hearts.
Even researchers have been scrambling to sort out what’s behind the seeming contradictions. Is it the type and mix of hormones that are making a difference? The timing of when women start hormone therapy and how long they stay on it? All of the above — and more?
Answers are still coming in, but meanwhile, thanks to studies already completed, doctors today have a more nuanced understanding of how to weigh the benefits and risks of taking hormones. Better information is helping them tailor prescriptions to individual patients. And an ever-growing number of new formulations offer options that may minimize dangers while still easing the often stormy passage through perimenopause and menopause.
The Long Goodbye
Typically, perimenopause starts in your 40s. It may take mere months or drag on for years. During this time, your ovaries shrink, causing drop-offs in the amount of estrogen and progesterone circulating in the bloodstream. But don’t think “gentle, steady decline.” Rather, hormone levels spike and sputter. That’s why periods become irregular or sometimes shockingly heavy. It also may be why some women struggle with irritability and moodiness that echo PMS but strike more randomly and, frequently, more often. Somewhere between 45 and 55, perimenopause becomes true menopause, which is confirmed only after 12 months pass without a period. After menopause occurs, estrogen and progesterone flatline at a low, even state that many women find more comfortable than the sudden fluctuations.