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Managing Menopause: What to Do?

Hormone Replacement Therapy May Be OK Short Term

Quality of Life continued...

Estrogen helps relieve symptoms, but would estrogen via a patch be safer as a long-term therapy? Research of the patch does not show as "robust" effectiveness as the pill, Hammond reports. Also, more research is needed of the progestin family of drugs. "We probably know less about progestin than estrogen."

"Each patient has to balance risks and benefits of hormone replacement therapy," he says. "Short-term use does not increase the relative risk of breast cancer.""

The verdict: "I see women every week whose quality of life is so poor, that I think there is still a place for estrogen until something better comes along," says Hammond.

Brain Function

"No protective effect against dementia" -- that was the WHI finding.

But further study has pointed to a different scenario for younger women, reports Hadine Joffe, MD, psychiatry instructor at Harvard Medical School.

"Women in WHI were over age 65; also, they had not taken HRT before," she points out. Indeed, hormone replacement therapy may help the brain function of younger women during the transition years between ages 50 and 55, Joffe tells WebMD.

"We're finding a window of opportunity in which estrogen can aid brain function," says Joffe. "There is some evidence that waiting longer before starting hormones may present a different scenario ... that when we replace estrogen in younger women, it can bring some immediate benefit. There's an indication that in the right context, women could see some benefit."

Younger women are a "very, very different population than older women," she says. A younger woman's brain has seen fluctuations of estrogen. "The 65-year-old woman hasn't seen estrogen for a number of years, so it may not respond the same."

These days, researchers can watch brains "in action" thanks to brain scans called functional magnetic resonance imaging (fMRI). While women perform various memory tests, they can see a "clear suggestion that various brain regions that affect working memory [and thinking] are enhanced [when women take HRT]. It supports the possibility that estrogen has direct effects on brain function."

Her advice: "The truth is, for the average woman who is younger, with hot flashes, mood problems, memory problems, we could see some improvement. I've heard women say it when they go on hormone replacement therapy, 'I'm back.' Hopefully it's validating for women who feel they're having memory problems, that it's not dementia, that it's just short term."


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