Here is a brief outline:
Hormone Replacement Therapy (HRT) as Safe and Primary Therapy
“Hormone Replacement Therapy (HRT) is safe and a first-line therapy for menopausal symptoms. Menopausal hormone therapy is indicated as first-line treatment of vasomotor symptoms (hot flashes) and is a safe treatment option for patients with no contraindications”– Canadian Medical Association, 2023.
HRT can be safely initiated in women without contraindications, less than 60 years old and less than 10 years post-menopausal.
Let’s read that again, shall we? “For patients with no contraindications, HRT is a safe and first-line treatment option”.
Unfortunately, in the past, these words have rarely been part of the conversation surrounding HRT. We are so glad we can finally use this vocabulary and provide women with the assurance and confidence surrounding treatment options for menopause.
Overcoming Misconceptions and Historical Fear
Fear and lack of education surrounding HRT have prevented menopausal women from receiving care.
“Although many treatments exist for menopausal symptoms, fears around the risks of menopausal hormone therapy and lack of knowledge regarding treatment options often impede patients from receiving treatment” — Canadian Medical Association, 2023.
A New York Times article earlier this year also addressed this issue, highlighting the widespread misinformation surrounding menopause treatment.
Health Benefits Beyond Menopausal Symptom Relief
HRT has health BENEFITS: on top of being 90% effective at reducing vasomotor symptoms such as moderate to severe hot flashes, it may reduce the risk of coronary artery disease (CAD) and improve cardiometabolic health.
HRT can significantly reduce symptoms of the genitourinary syndrome of menopause such as vaginal dryness and painful sex, as well as prevent urinary tract infections.
HRT also has a profound effect on BONE HEALTH:
“a 34% reduction in hip fractures, a 34% reduction in vertebral fractures and a 23% reduction in other osteoporotic fractures among women who took hormone therapy compared with those who did not” — Canadian Medical Association, 2023.
Readdressing the Risks with New Insights
Risks of HRT reported in the WHI (women’s health initiative) study were over-reported due to the advanced age of participants >60 years old.
The WHI first reported that patients treated with combined menopausal hormone therapy had an increased risk of invasive breast cancer (hazard ratio 1.2). However, the attributable risk is much lower among people aged 50–59 years, or among those who start treatment within the first 10 years of menopause, for whom the additional risk of breast cancer is estimated at 3 additional cases for every 1000 women who use combined menopausal hormone therapy for 5 years. — Canadian Medical Association, 2023.
Importance of Individualized Care
When starting a patient on menopausal hormone therapy, clinicians should consider the patient’s risk of disease, preferred mode of delivery (oral v. transdermal, combination v. separate dosing), need for uterine protection, and cost.
Duration of treatment after starting menopausal hormone therapy is no longer limited to 5 years, but rather is individualized, where the safest regimen is used at the appropriate doses to control symptoms.
The challenge with using HRT is that healthcare providers can’t use the same ‘flow chart’ approach as other conventional medications and conditions.
If you put a group of 50 perimenopausal women in a room together you might get over 100 varying symptoms and degrees of severity of symptoms.
Women need to be given the time and space to be listened to by their healthcare provider so the appropriate treatment options can be provided. Some women may also have other concomitant risk factors and health conditions which may also require further attention. Individualized care is necessary to optimize outcomes and support all aspects of health.
Our Conclusion
We can no longer dismiss menopause symptoms or merely endure them, as women may suffer for years without effective solutions. At NutriChem, all of our naturopathic doctors are qualified to prescribe bio-identical hormone replacement therapy to provide relief and support.
If you are interested in learning more about HRT and your options, book an appointment today.
The CMA release is just the tip of the iceberg in a sea of articles and position statements such as the updated 2022 position statement from the North American Menopause Society (NAMS) which has lit a fire in the mainstream media questioning why we have allowed perimenopausal and menopausal women to suffer for so long.
References
Guideline No. 422a: Menopause: vasomotor symptoms, prescription therapeutic agents, complementary and alternative medicine, nutrition, and lifestyle. J Obstet Gynaecol Can 2021;43: 1188–204.e1. Available at JOGC.
On May 15th, 2023 the Canadian Medical Association journal released an updated article outlining an approach to to management of menopause. https://www.cmaj.ca/content/195/19/E677
