By Dr. Diana Bitner
I am incredibly lucky to collaborate with so many talented healthcare providers to discuss a variety of important topics. Last week, I hosted a Let’s Chat session with Dr. Becky Lynn, and this week, I’m excited to partner with a world-renowned expert on Hormone Replacement Therapy (HRT). Dr. James Simon is not only my friend, mentor, and colleague, but also, he has been named “The Menopause Whisperer” by Washington Magazine! If you have been considering using HRT for your menopause symptoms (or are currently using it), keep on reading. This is one discussion you won’t want to miss. In this blog, I will explain why I care so much about HRT, give you five things you need to know about HRT and arm you with five questions you need to ask your healthcare provider.
Dr. Simon also happens to be a past president of both NAMS and ISSWSH, and I am grateful for everything he has done for women’s health. He was instrumental in convincing the government to pay for vaginal estrogen for women on Medicare, proving he is a leader in his industry, and I have a feeling he is just getting started!
Why am I telling you all of this about a man who practices thousands of miles away (Washington, D.C.) from here (Grand Rapids, MI)? Because I want you to know he is truly an expert on HRT and he is able to answer your questions with facts and years of experience.
I first began paying close attention to what Dr. Simon was saying about HRT after I watched him debate on a national stage at a North American Menopause Society (NAMS) meeting many years ago. He and another colleague, Dr. Steve Goldstein, were discussing the safety and indications of Hormone Replacement Therapy, including the pros and cons. It quickly became clear to me that Dr. Simon had an amazing command of the research, and, in fact, had been part of many of the studies himself. He also had a tremendous amount of experience taking care of women in midlife and menopause.
My own questions about HRT
I have been an OB/Gyn for 26 years and didn’t really think about HRT for the first 15 years of my career. However, as more and more patients started asking me about all the symptoms of menopause, such as hot flashes, night sweats, vaginal dryness (and many others), I decided it was my duty to know the facts. I was as confused as many of you out there because even among doctors, there seemed to be such a difference of opinion. But I wanted more than opinions; I wanted the best information possible so I could offer safe options to my patients and be able to be the expert. I had many questions about HRT: What was the correct dose? What type was best? When should a woman start taking HRT? How long should she take it? Did it cause breast cancer? Did HRT cause heart attacks or blood clots? Or did it actually prevent them? These are probably some of the same questions you have asked as well.
As I started seeing more patients who were taking HRT and were happy (no more hot flashes, increased energy, reduced vaginal dryness, etc.), I knew I had to find out as much as I could so I could help more women. So, I went to my first North American Menopause Society meeting and was blown away with the good information I could take back to my patients. The knowledge from Dr. Simon and others made me comfortable helping women make sense of safe options to treat the symptoms of midlife and menopause.
When we talk about menopause, it’s important to define what it is. Put simply, menopause is a natural decline in reproductive hormones (progesterone, estrogen, and testosterone), typically when a woman reaches her forties or fifties. As menopause occurs, a woman’s ovaries begin to run out of eggs, periods stop, and eventually her whole reproductive system shuts down. The result of the ovaries no longer making the hormones can be hot flashes, night sweats, vaginal dryness (leading to painful sex), bladder urgency, and many other issues. Since the symptoms of menopause are in a large part from low estrogen, it makes sense estrogen medicine would make symptoms better. Hormones help you age the want you want to age, so without them, your quality of life can suffer. Don’t you want to live your best life?
Questions from patients about menopause and HRT
Dr. Simon and I often get asked, “When is the right time to start HRT?” Dr. Simon said it best,
“The right time to start is when your symptoms are bad enough to disturb your quality of life.”– Dr. James Simon
The more difficult question our patients ask is, “When do I stop taking HRT?” The simple answer is that if it’s still safe for you to take HRT (no side effects, no other health issues, leading a healthy lifestyle), you can keep using it for as long as you want to take it.
Another common question women ask us is whether or not Hormone Replacement Therapy causes cancer. Our overwhelming response to that question is NO! Unfortunately, more than 20 years ago, the Women’s Health Initiative (WHI) gave estrogen a bad name and associated it with an increased risk of breast cancer. However, a massive study by the WHI found that estrogen DOES NOT cause breast cancer; instead, it’s more about when a woman starts hormone medication and what her risk factors are when starting the treatment.
What types of HRT are available?
So, now that we know HRT is safe for many women for the treatment of menopause symptoms, let’s look at the different types of HRT available:
- The estrogen pill works well for most women, especially for younger women who don’t have any risk factors for heart disease or blood clots.
- A non-oral form of HRT (patch, ring, gel, or lotion) works best for older women or women who are at high risk for heart disease or blood clots.
- A relatively new pill that is now on the market is called Bijuva. It has been proven safe and is the only FDA-approved pill that combines both estrogen and progesterone.
It’s important to note that some women can’t or decide not to take estrogen, including those women who have had breast cancer. However, there are other options besides HRT to consider. If you are thinking about using HRT to help with your menopause symptoms, first consult your healthcare provider. If he or she doesn’t have the answers to your questions or just isn’t comfortable talking about it, find someone who will! A Certified Menopause Practitioner (CMP) is specially trained in midlife and menopause health and can be a valuable resource for you. To find one near you, visit menopause.org.
5 things you need to know when considering using HRT:
- Know your phase of ovarian function—Are you in the reproductive phase, perimenopause (early or late), or menopause (early or late)? Knowing your phase can help you better understand why you are experiencing symptoms and how the hormone levels affect your risk for heart disease, diabetes, obesity, dementia, and osteoporosis.
- Use the Menopause Transition Scale (MTS) to list and understand your symptoms—Look at the seven common symptoms of menopause (Hot flashes/night sweats, Libido, Weight, Energy, Moods, Vaginal dryness/bladder complaints, Vaginal bleeding) and rate each one according to the scale I have created: (3) easy; (2) moderate; or (1) hard. To get an in-depth look at the Menopause Transition Scale, check out my “I Want To Age Like That” book and corresponding workbook. If you are a member of true. Women’s Health, you can also track your symptoms daily on our App to see if they improve.
- Have a clear and realistic goal—What do you want your life to be like in menopause? What do you hope to gain from using Hormone Replacement Therapy? Think about something that is difficult for you (night sweats, for example) and flip it around to a positive. Make your goal, “I don’t want to have night sweats.” Taking the HRT can help improve your night sweats (among other things), so keep that goal in mind when using the medications.
- Take the SEEDS checklist—HRT can help you feel better in so many ways during menopause, but it can’t do it all! Healthy habits make a big difference in menopause as well, and the Seven Essential Elements of Daily Success (SEEDS) is a way to get back to the basics. Living a healthy lifestyle is always a good start, and you will get the most benefit by doing your SEEDS daily and using HRT.
- Know your options for treatment—There are many factors to consider when deciding if HRT is the right option for you. We talked about the time to start, the time to stop, the pill versus the patch, risk factors, etc. Have a discussion with your healthcare provider to see what is best for YOU!
5 important questions to ask your healthcare provider if you are considering HRT:
- What is my phase of ovarian function? Are you in reproductive, perimenopause or menopause? You need to know where you’re at before you can figure out the best treatment for you.
- What is my risk to develop heart disease or stroke? Ask your provider about the Reynold’s Score and the CAC. The Reynold’s Score is used to help determine your risk of having a heart attack or stroke in the next ten years. The Coronary Artery Calcium (CAC) Score is a test that measures the amount of calcium in the walls of the heart’s arteries.
- What is my risk for breast cancer? Discuss your family history of breast cancer with your provider, and ask him or her about the Tyrer-Cuzick, a tool that estimates your risk of developing breast cancer in the next ten years.
- Are you a Certified Menopause Practitioner (CMP)? It’s important to take advice from someone who is knowledgeable on HRT—you deserve to know the facts and how they apply to you. I had a patient tell me her doctor said she couldn’t use HRT because the doctor’s grandma had breast cancer! Unfortunately, his lack of knowledge could have cost her years of good quality of health and an enjoyable sex life if she hadn’t decided to seek a second opinion.
- What is your understanding of HRT? Ask your healthcare provider what education he or she has had about HRT. Ask about the pros and cons and how they apply personally for YOU. If your doctor doesn’t know the answer, it’s time to find someone who does. Be your own advocate and don’t be afraid to ask for a referral to a Certified Menopause Practitioner. You can find one at menopause.org.
As always, we can help you with all of your HRT questions at true. Women’s Health. We treat patients every day who are either already using HRT or are considering them as an option for their menopause symptoms. We are here to help you live your best life during midlife and menopause!