A story that got a lot of media attention this week concerns a report from the Society of Obstetricians and Gynecologists of Canada (SOGC) that highlighted the benefits of using hormone replacement therapy (HRT) for the short-term treatment of symptoms in menopause.
The report didn’t really change much in terms of what the SOGC recommends about this still-controversial issue because that’s pretty much the same advice the SOGC gave a few years ago, namely, that for the treatment of symptoms from menopause, especially the treatment of hot flashes, nothing beats the use of HRT.
That reason the SOGC says it feels it needed to re-state this advice, though, and in a stronger manner than it has done in the past, is that according to the SOGC, lots of women in Canada who could benefit from HRT are not using it because of their fear about developing breast cancer, a fear that the SOGC says, is over-played and largely unfounded because the short term use of HRT is unlikely to raise the risk of breast cancer even minimally, and even in the longer-term, using HRT does not raise the risk of breast cancer substantially, and certainly it doesn’t raise it any higher than say, using alcohol does or even that following a sedentary lifestyle does.
The problems I see with all this, however, are these: first, there is no real consensus on “short term use”, so although the SOGC says that anything less than 5 years is short-term, lots of American institutions (including the authoritative National Institutes of Health) prefer to say that 2-4 years is short-term, and clearly, that means focusing on the lower end of that scale rather than on the upper (when you’re fifty, 5 years represents on average, about 15-20 % of the rest of your life).
Second, seems to me that if we lower the bar at all on the use of HRT, some physicians (and patients) will lower the bar a lot (that always happens with “guidelines”) so we run the risk that lots of women who start taking HRT in the short-term will extend their time on this “therapy” (why do we think that a natural event like menopause requires a therapy, anyway?), and I am certain that before too long, we will have lots more women taking HRT for a decade, even longer, and that will surely increase the number of women with breast cancer out there (studies have shown that the breast cancer rate in the US fell substantially in the years following the brouhaha over that Women’s Health Initiative (WIH) study that linked HRT with all sorts of bad outcomes including a higher risk of breast cancer, and most experts feel that the reason the rate of breast cancer plunged is that so many women stopped taking HRT as a result of the WIH study).
Bottom line is this: hormone therapy is the best treatment for severe menopausal symptoms (herbs don’t work, and some may even cause complications), so if you’re going through menopause, you have to first decide – for yourself and by yourself – how severe your symptoms are, and if you feel your symptoms are severe and are interfering with your life, you then have to decide whether you can minimize you symptoms by living a healthier lifestyle.
If you can’t do that, then you may decide to take some form of hormone remedy, so educate yourself thoroughly about the many, many choices – the type of hormone, for example, the form hormones can come in, the dose that you may need – and always, try to take the lowest dose of the longest-known (and thus presumably, the safest), weakest formulation that does the trick.
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