Taking Charge of Hormonal Health

Could hormone therapy be right for you?

By Stephanie Bouchard

Last November, the U.S. Food and Drug Administration (FDA) announced that it was removing the “black box” warning labels from certain hormone therapy products used to treat menopause symptoms in women. Citing years of research since the infamous 2002 Women’s Health Initiative (WHI) study that gave hormone therapy a bad reputation, the FDA is now signaling that hormone therapy, in certain circumstances, is safe and effective. What does that mean, and how do women determine if hormone therapy is the right choice for them?

The original WHI was a long-term national study of cardiovascular disease, cancers, and bone breaks caused by osteoporosis. Tens of thousands of women aged 50 to 79, with an average age of 63, participated in the study. When early results indicated that estrogen-plus-progestin therapy increased the risk of coronary heart disease, stroke, pulmonary embolism, and breast cancer, and estrogen-only therapy increased the risk of stroke and showed no protection against heart disease, an uproar about hormone therapy — often referred to as hormone replacement therapy or HRT — ensued. In the hullabaloo and fear that followed, much was lost in translation, with the end result being that hormone therapy wasn’t an option offered to or even considered for and by menopausal women.

In the decades since, research has continued and the old data from WHI has been re-examined, yielding insights such as women within 10 years of menopause, under the age of 60, get the most benefit from hormone therapy with little or low levels of risk, women age 70 and older get the least benefit and benefit varies for those in their 60s. Newer research also indicates that estrogen alone doesn’t necessarily increase the risk of breast cancer, and, in fact, when applied topically, is considered safe even for many women with a history of breast cancer. 

While the FDA’s removal of the black box warning from hormone therapies is largely being hailed as a positive step for women’s health, the removal doesn’t mean that hormones are risk free, said Liz Duke, a nurse practitioner who operates Bangor-based Integrated Wellness, a clinic focused on hormone and bone health. 

“There are still risks, but this is why you meet with a clinician and you talk about the risks and the benefits of hormone replacement therapy specific to you,” Duke said. 

As the fear about using hormone therapy diminishes, the question for many women is no longer whether hormone therapy should ever be used, but whether it makes sense for them. Making that determination starts with an assessment of your personal health history and symptoms, keeping in mind that symptoms can be much more than hot flashes and night sweats, said Dezireé Worster, a nurse practitioner who operates Hampden-based Synergy Holistic Wellness, where she focuses on women’s health.  

Menopausal symptoms are wide-ranging and can include heart palpitations, mood and cognitive changes, joint pain, muscle aches and stiffness, issues with urinary or reproductive functions or organs, and even itchy ears and tongues that feel like they’re burning. 

The FDA’s removal of the black box warning from hormone therapy gives women and their clinicians the opportunity to be more thoughtful about symptom management, Worster and Duke said. Instead of automatically prescribing antidepressants to a 49-year-old woman who is suddenly experiencing depression and anxiety, Worster said, “we should be thinking about their hormones.” 

Hormone therapy can offer relief from disruptive symptoms and may provide additional health benefits, but it is not a one-size-fits-all treatment, Worster and Duke emphasize. Guidance will evolve as research continues, underscoring the importance of individualized care. As women weigh their options now and into the future, Worster hopes the conversation keeps moving forward. 

“Hopefully the knee-jerk reaction for patients, but also their providers, will be education and not fear,” Worster said.