There has been a decisive turnaround in the discussion about hormone treatment for menopausal women: From now on, such treatment should only be given in cases of pronounced symptoms. This is the conclusion of the Federal Institute for Drugs and Medical Devices (BfArM). The reasons for this significant reassessment are the risks that have been highlighted in several published studies: According to these, hormone treatment during menopause increases the risk of developing breast cancer and ovarian cancer. There is also an increased incidence of thrombosis, stroke and heart attack.
Clear consequences
Drugs for the treatment of menopausal symptoms should therefore only be used in cases of pronounced symptoms and if the quality of life is severely limited by the symptoms. And even then, the BfArM recommends that the treatment period be kept as short as possible, using the lowest effective dose. In addition, it was ordered that in the future drug manufacturers must list all of the above-mentioned risks in the product information. It is also recommended to check whether it is possible to stop treatment in women who have been taking hormones for many years. It has not yet been discussed whether hormone treatment for the prevention of osteoporosis, i.e. bone loss, will still be included among the clear areas of application.
Hormone therapy: study results
The results of one of the world’s largest studies on hormone therapy for menopausal women has given a decisive turn to the discussion that has lasted for years. That’s because the British “One Million Study,” which involved more than one million women, confirmed that treatment with menopausal hormones significantly increases the risk of breast cancer. And this was true regardless of which hormones were given and whether the treatment was via tablets or patches. Also irrelevant was whether the treatment was continuous or involved breaks between doses.
Increased risk of breast cancer after hormone treatment.
An increase in risk was apparent after just one year of hormone therapy, and the longer the treatment lasted, the greater the risk of developing breast cancer. Here, the risk was somewhat lower when the women received a preparation containing only estrogen than when both estrogen and progestin were taken. Reassuringly, after stopping hormone treatment, the risk of breast cancer decreased again.
Side effects of hormone therapy
Another study that had a big influence on the current decisions was the so-called Woman’ s Health Initiative. It involved 16,000 women between the ages of 50 and 79. Originally, the study was supposed to take place over eight years. But it was stopped prematurely last year. This was because an interim evaluation of the data after five years had revealed that women taking hormones were more likely to develop breast cancer than women who only received placebo, i.e. tablets containing no active ingredients. Other alarming results: Hormone treatment increased the incidence of strokes, pulmonary embolisms and heart attacks, especially in the first year of treatment. The positive effects were that women with hormone treatment were less likely to develop colorectal cancer and also suffered fewer hip fractures than women without treatment. Nevertheless, this “added value” in no way outweighed the risks.
Hormone therapy: who wants to stop
Affected women who want to use this discussion as an opportunity to stop treatment should not simply discontinue the drug. Go to your gynecologist and ask for a detailed discussion. For yourself, you should first clarify how much the complaints are actually affecting you. After all, your well-being will ultimately be a basis for your doctor’s decision. But remember: menopausal symptoms are sometimes stronger, sometimes weaker, and sometimes they subside completely after just a few months. Maybe you’ve been taking hormones for a long time without really needing them anymore? Or you think that the symptoms have only improved because of the hormones, but your body has already changed.
Discontinue hormone therapy only under supervision
Especially if you have been practicing hormone therapy for several years, you should therefore try to stop. To do this, ask your doctor for help. He will advise you on the gentlest way to stop the treatment.In principle, hormones should not be discontinued from one day to the next. This could provoke symptoms such as sweating and hot flashes again, especially if high doses of hormones were previously taken. It is better to reduce the dose slowly and see how you feel. And always think about it: Are these complaints really affecting my life as much as I thought, or is it just the fear of the complaints? Maybe you’re coping better with the bothersome symptoms by now, or maybe they’ve even disappeared altogether.
When it does have to be hormones
Nevertheless, there will still be sufferers for whom hormone therapy is the right solution. Especially those women who suffer very strongly from the aforementioned complaints and are extremely impaired in their professional lives, for example. This is because studies have shown that hormone therapy works well against menopausal symptoms such as sweating, hot flashes or sleep disturbances and has also proven to be effective. For this reason, the doctor will discuss with the woman concerned whether hormone treatment is appropriate or not in the particular case. If a longer treatment is necessary, it must be checked annually whether the treatment is still useful. In doing so, the doctor should prescribe the lowest possible dose. Normally, a woman will be prescribed a preparation that contains estrogen and, on at least ten days per month, additional progestin. This is necessary to prevent neoplasms of the uterus. However, if the uterus has been removed, only a pure estrogen preparation will be prescribed. Women who take hormones must be made aware that this may cause changes in breast tissue. Therefore, self-examination of the breast should be a matter of course. In addition, at regular intervals the gynecologist must palpate the breast for changes, and a mammogram should be performed annually while on hormone treatment.
Hormone therapy: risks and contraindications
Under no circumstances should hormone therapy be performed if certain contraindications exist. No matter how severe and distressing the symptoms are. These contraindications, reasons that prohibit hormone therapy, include breast cancer and ovarian cancer. Women who have a history of vascular disease, such as deep vein thrombosis or pulmonary embolism, are also excluded from hormone therapy. The same applies if a woman has recently had a heart attack or suffers from angina pectoris. This is because these conditions greatly increase the known risk factors for hormone therapy. Particularly close monitoring during hormone treatment is necessary if a close relative in the family, i.e. mother, sister or daughter, has breast cancer. Likewise, if a woman smokes or is very overweight, because then the risk factors for vascular disease are higher than in other women. Another disease that requires regular, close monitoring is Lupus Erythematosus, an autoimmune disease. Treatment must be discontinued immediately if very high blood pressure values suddenly occur or a woman experiences severe migraine-like headaches for the first time. This could be a precursor to a vascular disorder. Incidentally, taking hormones to prevent osteoporosis always means long-term treatment. This is because the protective effect can only develop over a longer period of time. Since longer treatment is also associated with a greater risk of side effects, this treatment indication should be weighed very carefully. In principle, alternative preventive measures should be intensively considered here.
Hormone therapy: healthy alternatives
The best alternatives for menopausal symptoms are – in short – all those that increase physical well-being, e.g. conscious nutrition, regular physical exercise. These are all-natural ways to prevent osteoporosis, feel more powerful all around, and help the body get over menopausal symptoms like fatigue and sleep disturbances. Reducing coffee and nicotine consumption can also help alleviate symptoms. Diet: In order to prevent osteoporosis, the diet should include sufficient calcium intake. Calcium is found in milk and dairy products. Calcium-rich mineral water can also supply the body with plenty of calcium.Otherwise, a diet rich in vitamins and minerals is advisable, which gives the body the necessary fitters for daily life. Sport: It is also an important factor in the prevention of osteoporosis. But not only that: sport also lifts your mood, you feel more balanced and more efficient. And plenty of exercise in the fresh air is the best remedy for insomnia. Sports physicians now recommend walking, but it should be 2.5 hours a week – and the more often, the better. According to a survey of 70,000 healthy participants in the WHI (Women’s Health Initiative), women who exercise regularly after menopause are less likely to suffer a heart attack than those who do not. The pulse rate should not exceed 180 minus age, then the load is correct and is also good for the heart.
Hormone therapy: herbal alternatives
There are also herbal remedies, so-called phytopharmaceuticals, to alleviate mild menopausal symptoms. Extracts from the rhizome of Cimicifuga racemosa, the black cohosh, are often prescribed to help with hot flashes, sweating, irritability, and vaginal dryness. They contain phytoestrogens, plant estrogens. The preparations are also said to have a bone-protecting property. And extracts of black cohosh are not thought to have any adverse effect on the mammary glands. There are differing opinions on preparations made from red clover or soy, which also contain phytoestrogens, regarding their efficacy in menopausal symptoms. A recently published study showed, for example, that the plant estrogens from red clover, so-called isoflavones, are no more effective against hot flashes than placebo. Sage, however, is said to have a mitigating effect. If dejection and depression are also involved, the doctor should be asked whether a therapy attempt with St. John’s wort makes sense. However, it is important to know that treatment with herbal preparations only takes effect after a longer period of use. About four to six weeks it takes on average, until it comes to a first relief.
A stage of life
Perhaps it helps some women to remember that menopause, like puberty, is part of life. Both are not diseases, but stages in certain phases of life. The problem, of course, is that the two phases are valued differently: After all, puberty is the gateway to life, the springtime, so to speak, when everything awakens. Menopause, on the other hand, announces: The summer of life is over, it goes into the autumn. But: Autumn also has many wonderful sunny days, and with today’s life expectancy, that can still be quite a few!
