Menopause Hormone Therapy - an anti aging strategy?

First off this is neither a pro or anti hormone therapy post. Also, as a non clinician I’m not qualified to advise anyone on this subject. So this is more of a signposting post to help anyone find credible sources of information.

When I first started researching treatment for the brain fog, hot flashes & sleep issues I was having back in my peri menopausal days I came across lots of voices claiming that Menopause Hormone Therapy (MHT, previously & often still referred to as HRT) could help prevent dementia, heart disease, my bones crumbling, help with maintaining my fitness, all in addition to addressing menopausal symptoms. Having had breast cancer with a hormonal aspect MHT was off the table & I felt doomed to suffer as a result. Fortunately I now know that the scientific world and all the menopausal societies don’t see it as an all dancing fix for every change we as women experience. And if you think that taking Hormone Treatment means you can sit on your hands & not lift weights or up the intensity of cardio to maintain speed & strength, then think again. The same behavioural strategies to combat muscle & bone decline & maintain performance are just as relevant for those getting hormone treatment as for those who don’t.

This white paper https://www.imsociety.org/wp-content/uploads/2024/10/Menopause-and-MHT-in-2024-addressing-the-key-controversies-an-International-Menopause-Society-White-Paper-1.pdf?v=5f02f0889301 discussing the controversies related to MHT produced by the Menopausal Society is an excellent read, as they state, menopause treatment has a rocky history. Here’s an extract related to the reporting of the Women’s Health Initiative study that caused many clinicians and women still today to be fearful of hormone therapy.

"The initial reports from the women’s Health initiative (WHI study in the USA in 2002 and the Million women Study (MWS) in the UK in 2003 resulted in a significant decline in the use of MHT (by 80%) due to concerns about the reported risks of cardiovascular events and breast cancer.

The reporting of these two studies came as a shock to conventional wisdom. Prior to this, MHT was viewed extremely positively because of the favourable findings of observational studies, which led to women being regularly counselled about use of MHT for preventive reasons, as well as for symptom relief.

Although the absolute risks of MHT on health outcomes in the WHI were rare to very rare by common standards, the data were alarmingly presented as percentage changes rather than absolute numbers by the media, and the risks were said to apply across all age groups. the fall in prescribing, especially in primary care, resulted in many women ‘suffering in silence’ and seeking other solutions for their symptoms.

Numerous subsequent WHI publications following the initial report demonstrated that the problems were mainly in the older age groups and probably due to the particular types and doses of hormone therapy used in the WHI Yet many women and their prescribers were still too anxious to return to use of MHT"

Arguably today, the pendulum has swung too far the other way again to the extent that some have the impression that menopause hormone therapy “replaces” your natural hormones and therefore essentially keeps you in a premenopausal hormonal state. That’s simply not true. The levels of Oestrogen & Progesterone are lower than during the reproductive years.

It’s also not true that not every single woman needs it. Many women who feel great, perform well, have good cardiovascular health, and strong bones without hormone therapy. If you need and/or want it, that’s great, but there are also alternatives, behavioural & pharmaceutical.

If you are considering MHT: DO discuss with a Dr sooner rather than later. There is a window of opportunity up to 10 years after your last period when MHT maybe suitable, with a lower risk profile. After this time the risk benefit changes. Also be aware that not all clinicians have an interest or much training in menopausal health so you may need to shop around to find someone very knowledgeable. In the UK the revised NICE guidelines for MHT are due to be published and the Menopausal Societies are a good starting point for basic information about the different types of MHT. I'm thankful that we no longer live in a world where patients are expected to be passive recipients in the hands of experts and that the Dr-patient relationship is more often a partnership dialogue.

I highly recommend you follow Dr Jen Gunter who regularly reports on the latest scientific findings. I love her no nonsense writing. It's thanks to her reporting that I know that MHT whilst it helps bones stay strong is not indication to reduce your Dementia or Heart disease risk and that vaginal oestrogen cream is available even for people like me.

Here's what she wrote this year from the annual menopause conference https://vajenda.substack.com/p/eight-takeaways-from-the-2024-menopause?utm_source=substack&publication_id=269202&post_id=148968966&utm_medium=email&utm_content=share&utm_campaign=email-share&isFreemail=true&r=12ugzx&triedRedirect=true

For me personally, I'm still disappointed I don't have access to MHT for my bones but this situation pushes me more, to do all the things we should all be doing. Things like better stress management now that my hormonal cortisol buffer is no longer helping out, lifting heavy weights to keep my muscles and bones strong, a bit of intensity to help with the slow down. So for that extra shove, I'm grateful.