Women losing out over hormone therapy fears, some experts say

The risk of heart attack, stroke or breast cancer due to hormone replacement therapy has been overstated, and that has scared away some women who could benefit from it, the Society of Obstetricians and Gynaecologists of Canada said at its annual conference in Ottawa this week.

The SOGC says HRT is not the scourge it was once considered to be.

A generation of women were denied the opportunity to have better health.- Dr. Robert Langer

"I do think that a generation of women were denied the opportunity to have better health," said Dr. Robert Langer, who spoke at the conference.

For decades, HRT was the go-to treatment for women experiencing symptoms of menopause that can include night sweats, insomnia, depression, anxiety and hot flashes, and was even thought to have a protective effect against bone density loss and heart disease.

In 2002, however, the U.S. National Institutes of Health (NIH) prematurely ended a massive study involving thousands of women when it was discovered HRT failed to protect against heart disease and increased the risk of heart disease as well as blood clots, stroke and breast cancer.

That finding "seemingly turned the world upside down," said Langer, medical director of the Jackson Hole Center for Preventive Medicine and a lead investigator in the original NIH research.

The fear "spread like wildfire and turned the tides so that women stopped considering HRT even for symptom relief, which is the most important use of it and the reason that most women would start."

No need to be 'fearful'

Symptoms can start five to 15 years (perimenopause) before a woman reaches menopause, defined as the point at which she has gone without a menstrual period for a year.

"Women who are having disruptive symptoms of menopause, they do not need to be made fearful of making a decision that makes a huge improvement in quality of life," said Dr. Jennifer Blake, CEO of the SOGC.

• How grandmother orcas help explain the evolution of menopause

Blake said that before it was stopped, the NIH study found there was an increased risk for breast cancer in older women undergoing hormone therapy — the average age of the subjects was 63, long past the average age of menopause, which is around 51.

The study also confirmed that the risk was higher for women who were using the combination of estrogen and progesterone, and that treatment using estrogen alone actually lowered breast cancer risk.

"A relook at that data and a number of studies of younger women gives an even more interesting set of findings," Blake said. For young women, the heart benefits of hormone therapy are "very real," and the risk of breast cancer "remains a small number."

The confusion about the safety of HRT came from misapplying the findings to younger women, and the fear that generated has persisted, Blake said. She said doctors themselves take hormones for menopause because "we are familiar with the whole body of knowledge." 

'Back to where we were'

Langer called the study results "most inflammatory" and said, "It has taken us 15 years ... to come back to where we were in 2002 and recognize that for younger women, this is an appropriate treatment. In fact, major societies in this field have now come around with revised recommendations."

The NIH revised its guidance in 2013, saying hormone therapy is "not recommended for the prevention of chronic disease but may remain a reasonable option for the short-term management of menopausal symptoms for younger women."

But not everyone is in full agreement.

The Canadian Cancer Society recommends that women "avoid taking HRT for any reason other than to relieve severe menopausal symptoms that have not responded to other treatment."

Health Canada continues to warn of "significant risks" associated with the therapy on a web page that hasn't been updated since 2006.

'Grown-up conversation'

Experts generally agree HRT can be beneficial in certain cases, with certain types of patients, and that it is generally safe if used judiciously.

"The pendulum ... may have swung too far, because for some women in some circumstances it can be a very effective treatment," said Dr. Danielle Martin, a family doctor at Women's College Hospital in Toronto.

• Why don't women talk about perimenopause?

"What we need to have is the grown-up conversation about risks versus benefits, and we need to make that conversation personal and individual to each woman," said Martin, the author of Better Now: Six Big Ideas to Improve Health Care for All Canadians.

The founder of the Menopause Chicks website said women have to arm themselves with information, ask questions and decide on the best course of action for themselves.

"I think it comes down to the fact that we have never been taught how to be our own best health advocates," Shirley Weir said.

"Messages from the media, messages from advertisers...we kind of get convinced that there's a magic-wand solution or a one-size-fits-all solution. The reality is that the future of health care is personalized: what's right for me today at this age is not going to be what's right for you."

The bigger problem, Weir said, is that the majority of women she speaks to don't have anyone to talk to about menopause.

"The first leap we need to make is to create a space where women can access information that is going to help them make the best decision for them."