Transcript
Dr. Jill Liss: Hi, I'm Dr. Jill Liss. I'm a board-certified OB-GYN, Menopause Society Certified Practitioner, and Associate Clinical Professor of OB-GYN. Today we're talking hormone therapy. You've probably heard of it. Who's a good candidate? What are the risks and benefits? We'll try to cover all of it.
Ambassador: Who is a good candidate for hormone therapy and who can benefit from this treatment?
Dr. Liss: The most ideal candidate for hormone therapy is someone who's generally healthy, relatively young, less than age 60 or within 10 years of menopause, and who has symptoms that would benefit from hormone therapy, like hot flashes and night sweats. Those people are likely to experience great benefit and minimal risk.
It's really important to talk to your doctor about whether or not your personal health history makes you a good candidate or not.
Some areas where we want to have extra caution in using hormone therapy or potentially not be able to use hormone therapy are when somebody's had a history of an estrogen-sensitive cancer, like breast cancer, has high risk cardiovascular disease, has a history of stroke or blood clot, or liver disease. These are circumstances where we often avoid and use non-hormonal alternatives first.
But these cases are nuanced and it's really important to have a conversation with somebody who's knowledgeable.
Ambassador: When is the best time to start hormone therapy? What signs do I need to look for?
Dr. Liss: When to start hormone therapy is highly individual. There's not one age, one symptom, one perfect protocol that's going to work for everyone. In general, not everyone should take hormone therapy, and it's not like it should be started preventatively ahead of menopause. We do not recommend hormone therapy universally for prevention of disease.
It should be used when someone is symptomatic. You do not need to be miserable from symptoms before you start hormone therapy. So the right time to start is when you have symptoms or a compelling medical condition, and it feels like the right time between the discussion between you and your healthcare provider.
Ambassador: So, what are the potential benefits of hormone therapy?
Dr. Liss: There are several benefits to hormone therapy, but the benefits and the range of benefits depend a lot on personal characteristics going into starting hormone therapy. The most profound benefits are related to treating vasomotor symptoms or what we call hot flashes and night sweats, as well as preventing osteoporosis, and for treating the Genitourinary Syndrome of Menopause, or that loss of estrogen on the tissue at the level of the vagina, bladder, and urethra.
Ambassador: What are the risks and side effects of hormone therapy, including long-term ones?
Dr. Liss: Side effects of hormone therapy are not common and typically not severe. But the most common, particularly recently after starting, are what I like to call the three B’s: bleeding, bloating, and breast tenderness. Typically, with ongoing use, these will resolve on their own, but certainly, you'd want to let a healthcare provider know if they continue.
Significant risks with hormone therapy are considered rare, typically on the magnitude of less than 10 per 10,000 women. Some of these risks include stroke, blood clots, increasing risk of breast cancer, and this happens typically after five years of use and increases with ongoing duration, as well as increased risks of gallbladder disease or cholecystitis.
Ambassador: How long can I stay on hormone therapy? Is there an age limit? Do I have to be on it for a certain amount of time? And what happens to me after I stop taking it?
Dr. Liss: How long somebody will need to use it really depends on why we're using hormone therapy in the first place and how that person is responding. For many people, the symptoms of perimenopause and menopause are most severe for about seven years, but then often resolve and no longer require treatment. So, if you're one of those people and symptoms go away, you may be a great candidate to stop hormone therapy.
Other people, for different reasons or priorities, may need to continue on it indefinitely. And in the right candidate, as long as there's an ongoing discussion of risks and benefits, as their health evolves with aging, it can be appropriate to stay on it with no particular end date.
While hormone therapy is a powerful tool and can be life-changing for those who need it, it's not necessarily for everyone, nor is it always needed. If you do have symptoms and are not a candidate for hormone therapy, also remember there are really safe and effective non-hormone therapies that can be prescribed to make sure you're not suffering.
Be sure to talk to your doctor about your options, what you're a good candidate for, and advocate for your health and well-being so that you can manage this transition with power.