One of the most important reasons that I got my prescribing license was to prescribe menopausal hormone therapy (MHT), formerly known as HRT, and I took extensive training, with the utmost evidence-based NDs, to be able to feel very confident doing so. I was not always so excited about hormone therapy, so I want to tell you more about that.
I was actually pretty scared of hormone therapy in the past, to be honest, and research shows that I was not alone! Not only was there the Women's Health Initiative study in the 90s that showed many detrimental effects (hence the persisting fear of MHT in many), but also it just didn't feel "natural" to be replacing hormones that had decided it was their time to go. Plus, with the tools I used for menopause already, I did a pretty darned good job at easing that transition.
But, watching the struggles in the (peri)menopausal years of both my patients and those around me, and knowing there was something that could ease those troubles even further than what I did already, plus prevent issues post-menopausally, I started to feel that it was actually a great disservice to my patients to not offer hormone therapy. Not only was it often more effective than the other tools, plus newer forms do not carry the same risks as the danger years, and most importantly it offered proven preventative protection of the below conditions, and prevention is a key tenet of Naturopathic Medicine.
MHT benefits include improvements in:
- Hot flashes/night sweats (gold standard treatment)
- Sleep (even independent of night sweats)
- Depression (perimenopausally or very early menopause only)
- Possibly prevent loss of muscle mass, strength, and performance (in combo with exercise).
- Vulvovaginal, and sexual health (vaginal atrophy, dryness, libido, etc.)
- Bladder health (overactive bladder, painful urination, UTIs, etc.)
MHT offers prevention of:
- Type 2 diabetes
- Adipose (fat) mass.
- Colorectal cancer
- Osteoporosis (which might be hard to care about before it affects you, but let me tell you- quality of life and independence can be massively affected by this)
- Cardiovascular disease
- MORTALITY! (I'm not even kidding, it lowered all-cause mortality rates).
Now there are still risks to MHT, which I wanted to be very careful about- so if you are interested in exploring it, we will thoroughly evaluate your specific suitability to the treatment. I will provide the risks and the benefits so that you can make an informed decision.
With regards to the aforementioned detrimental study, it used:
- Oral estrogen - now we prefer transdermal estrogen for its greatly reduced risks.
- Synthetic progesterone - now we prefer micronized progesterone for its safety profile and efficacy.
- Inappropriate age range - we now know the risks increase if initiated after 10 years post-menopause, or after age 60. Vaginal estrogen is very safely available for patients that lie outside of that optimal time range.
So we can now avert many of the risks of that study!
The lecturer of one of the multiple trainings I did made a very good point - we are now often living half our lives in menopause! So while the hormones have decided it's their time to go, our lives have lengthened substantially, and we need to lengthen that estrogenic protection of our bones and our colons and our blood vessels and our metabolism!
So if you, or someone you know, is struggling with (peri)menopause symptoms, or even if you're just curious to know more, please book in and I will happily walk you through the risk:benefit analysis for your individualized picture!
In health,
Dr. Shayla