Por: Red Hot Moms
Posted: September 11, 2015
Contribution by Dr. Michael Goodman, MD - Red Hot Mamas Medical Expert
This is a question I am often asked: “…How long should I continue hormone therapy…” “…When should I stop…?”
If you take estrogen with or without progesterone, should you stop taking estradiol and progesterone, and if so, when?
The answer is indeed evidence-based and has evolved over time since the abomination of doublespeak, the Women's Health Initiative ("WHI") study was prematurely leaked/released.first to the press, and then, (with nearly half of the researchers refusing to sign off on the paper due to what they perceived as bias) to the scientific community by the principal investigator in 2002. The main point of that paper, that "... estradiol causes cancer..." , and that hormone therapy (“HT”) does not improve cardiovascular health or cognitive abilityIt was later shown to be fake., but most general practitioners (GPs, PCPs, internists and many general obstetricians and gynecologists) have not followed the literature and continue to avoid HT. It is instructive to note that the vast majority of "Menopause Practitioners" (specialists in the treatment of menopausal women) definitely encourage and support the use of estradiol and progesterone. First, they never believed the biased conclusions of the WHI.
The North American Menopause Society (the world's largest professional society of physicians and researchers dedicated to menopausal medicine) issued a "Statement on the Continued Use of Systemic Hormone Therapy After Age 65" in July 2015 (1) in which he recognized clear data showing that troubling menopausal symptoms, such as hot flashes and sleep disturbances, persist for a period of time.average of 7.4 yearsand for more than a decade in many women. (2) Moderate to severe hot flashes, fatigue, and sleep problems were documented in 42% of women aged 60 to 65 years; therefore, many postmenopausal women who choose not to take hormones, or women who take estradiol for only a few years and stop, will continue to have disturbing symptoms after age 65, and these symptoms can interrupt sleep and negatively affect their health. health and sleep quality. life. (2-4)
The Statement goes on to say: “Provided the woman has been informed of the increased risks [in certain situations] associated with continuing HT beyond age 60 and has clinical supervision, it is acceptable to extend the use of HT at the shortest effective dose… as for the woman who has troublesome and persistent menopausal symptoms and for whom her physician has determined that the benefits of HT outweigh the risks.” (1)
Little by little, consistent data are clarifying the issue and corroborating what I have been editorializing for many years: In the absence of a pathological process that makes the withdrawal of estradiol and/or progesterone advantageous, there is little reason to abandon hormone therapy. how one ages after age 60 and beyond.
There are strong data to support the continuation of estradiol therapy as a woman ages.It is well known that estradiol improves lipid parameters, decreasing LDL-C (low-density or “bad” cholesterol), improving HDL-C (high-density or “good” cholesterol) and, transdermally (through the skin) or subdermal (granules implanted under the skin) - improvement of triglycerides (perhaps the most dangerous lipid particle) - scores. Estradiol is also known to improve memory and cognitive function and improve/decrease the aging of the skin's collagen layer. The caveat here is that estrogen supplementationit should be started up to 10 years after the last menstruation, but the sooner the better; I personally feel 7-8 years oldis a better cut-off point for safely starting estradiol. Continuous HT prevents bone demineralization and supports healthy bone mineral density, which prevents osteoporotic fractures. Continuing HT through the aging process supports memory and cognitive clarity. Undoubtedly, the use of local vaginal estradiol therapy (with or without "systemic" HT) promotes a healthy, youthful lining of the vaginal mucosa, eliminating the often troublesome postmenopausal symptoms of vaginal burning, discomfort with sexual intimacy, and incontinence. . And, perhaps of lesser "medical importance" but certainly important for women, is the thicker, more resistant layer of collagen in the skin of women who take HT compared to those who don't.
A clear and unambiguous editorial in the leading medical journal devoted to menopausal issues ("Menopause"), entitled "Failure to treat menopausal symptoms: a disconnect between clinical practice and scientific data.says the best.Andrew Kaunitz, MD and JoAnn Manson, MD, both highly respected menopause researchers and board members of the North American Menopause Society, point to the recent paper on the prevalence of bothersome menopausal symptoms for a decade or more after menopause (3). , opining, “…Confusion and anxiety regarding the safety of TH have led to sharp declines in the prevalence of TH use…documented not only in the US but also in Australia, Germany and other European countries. Currently, only 5% of women in the US use HT, and use is higher in healthier, more educated populations. “The WHI is commonly cited as demonstrating that HT use carries high risks, a belief that contributes to low HT use among symptomatic postmenopausal women. Indeed, a close look at the 2013 report that thoroughly analyzed the WHI data(5), published in the prestigious Journal of the American Medical Association ("JAMA“), demonstrates that HT use is associated with a risk-benefit profile that many postmenopausal women would find acceptable…” and that “…neither estradiol nor estradiol/progesterone therapy affected overall mortality rates” . (5) Another way to look at it, according to Manson and Kaunitz, is that the elevated risk of breast cancer after 10 years or more of continuous use “…translates into an attributable risk of less than one additional case of cancer breastdiagnosed…” (remember, >75% of women survive breast cancer!) “…for every 1,000 HT users annually. This risk is slightly greater than that seen with one glass of wine a day and less than the health risk seen with two drinks a day…” The scientific data supports HT, but many doctors accept it!
But, I've previously opined (with references) about the harm wrought to women's health by the WHI (see previous blogs on this site). So... here it is, an elderly woman (50, 60, maybe 70, post-menopausal). How long should I stay on hormone replacement? Should I stop using estrogen/estradiol? Should you give up progesterone? Should you stop? And, if your doctor decides to lower your dose as you age, or if you or your doctor decides to stop HT, what is the best way to "quit smoking"?
There is definitely a "protocol" for weaning/weaning HT with estradiol and/or progesterone. Do not stop suddenly under any circumstances;slowlySharpbelow! For my patients who go down from one dose to the next lower dose, I ask them to do so by progressively cutting slivers of their patch or alternating every third day (then every other day) with 1/3thirdo la mitad de la dosis más baja de crema o gel, taking 3 to 4 full months to pass to the following dosis más baja y, if you completely stop estradiol or progesterone, take 6 months to a year to stop to take. If weaning is due to a diagnosis of Estrogen/Progesterone Receptor Positive Breast Cancer, I reduce this reduction to a period of 6-8 weeks (there really is no reason to say "OMG, OMG, I need to stop doing this".Immediately!), starting them simultaneously with supplements and other non-hormonal treatments for menopausal symptoms, in order to cushion this difficult transition.
References:
- North American Menopause Society statement on the continued use of systemic hormone therapy after age 65.Menopause2015;22:693.
- Avis NE, Crawford SL, Greendale G and others; Study of Women's Health in the Country (SWAN). Duration of menopausal vasomotor symptoms during the menopausal transition.Internal Medicine JAMA 2015;175:531-539.
- Gartoulla P, Worsley R, Bell RJ, Davis SR. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years.Menopause2015;22:694-701.
- Kaunitz AM. Prolonged use of menopausal hormone therapy,and pauses2014;21:679-681.
- Manson J, Chlebowski R, Stefanick M, et al. Menopausal hormone therapy and health outcomes during the intervention and extended post-discontinuation phases of the Women's Health Initiative randomized trials. JAMA 2013;310:1353-1368.