Changing the Narrative on Menopause

I don’t remember a lot of the things that I learned in medical school and can confidently admit that. Does that make me a bad doctor? I don’t think so, but I will leave that to you to decide. When you are drinking from a fire hose, you are bound to spill more water than you drink.

One of the topics that I did not forget— menopause—not because it was taught so well and clearly, but because it wasn’t taught at all. Truly, nothing.

Nothing may be dramatic. I’m sure there was a basic science lecture somewhere about female hormone decline caused by dwindling numbers of remaining ovarian follicles leading to hormone fluctuations and eventual cessation… But real-life menopause education? Nothing.

If anything, I left medical school knowing the definition of menopause (a period of 12 consecutive months without a menstrual period) and that it was inevitable, a “right of passage” for any female that lived long enough.

Fast forward to residency where surely there would be more useful education, right? After all, residency is where you take the book knowledge of medical school and apply it to real life people. If you assumed that like I did, you would again be incorrect.

If anything, I learned in residency that non-hormonal treatment options exist, most of them being anti-depressants, and that hormone replacement was largely unsafe.

If you had a conversation with me about female hormone replacement at the start of my post-residency career you would have heard exactly what I was taught—menopause is inevitable, all women will go through it, there are some medication options that can help, hormones are bad, and best of luck.

If that is a conversation we have had, I sincerely apologize. That couldn’t be further from the truth. Thank you for teaching me, being patient with me, and forcing me to think critically and learn more.

I could go into the reasons as to why medical education is this way, but I will spare you the boring details. What I do want to leave is this—

Menopause is inevitable for all women who live long enough, that much is true. The thought that it is a right of passage that must be “powered through” is false and downright unhelpful. There are many options to help during this transition of hormone chaos. Some are not hormones, but many of them are and for almost all women some form of hormone replacement is safe, FDA approved and can lead to significant health benefits both in the short and long terms.

What is Hormone Replacement Therapy (HRT)?

Hormone Replacement Therapy involves supplementing the body with hormones—mainly estrogen and progesterone—that it stops producing as menopause approaches. The primary goal of HRT is to alleviate the symptoms caused by hormonal changes, such as hot flashes, night sweats, mood swings, and vaginal dryness. Additionally, HRT can help protect against bone loss and reduce the risk of osteoporosis, support the cardiovascular system, and help maintain muscle mass and avoid body composition changes often seen during this time.

Perimenopause vs. Menopause

Perimenopause: This phase can start as early as a woman’s 30s or 40s and is characterized by fluctuations in hormone levels, which can lead to irregular periods and the onset of menopausal symptoms. During perimenopause, HRT may be prescribed to balance these fluctuating hormones and provide relief from symptoms. If there is one area that we know that HRT is beneficial it is during this time as a significant support in boosting a woman’s quality of life.

Benefits of HRT

Symptom Relief: HRT is highly effective at reducing common menopausal symptoms like hot flashes, night sweats, and mood swings.

Bone Health: Estrogen helps to maintain bone density, reducing the risk of osteoporosis and fractures.

Heart Health: There is some evidence that HRT may have protective effects on the heart when started around the time of menopause.

Body composition: There is some evidence that HRT helps to maintain muscle mass that often occurs during this transitional period.

Myths Surrounding HRT

Despite its benefits, HRT is often underutilized due to persistent myths and misunderstandings. In the 1990s, a large study was conducted called the Women’s Health Initiative (WHI). This study was a major clinical trial that investigated the health effects of hormone replacement therapy (HRT) among postmenopausal women, among other health issues. The WHI concluded that there was an increased risk of breast cancer in women who used combined estrogen-progestin HRT. This conclusion sent shockwaves throughout the medical community and popular media, leading to a significant decrease in HRT use as well as significant halt to menopause research. More recent analysis of the data from the WHI, as well as additional studies, has calmed many fears and provided a more nuanced view of the risks and benefits of HRT. While there is a small increase in risk for some women, especially with prolonged use, this risk must be balanced against the benefits of symptom relief and improved quality of life. Another myth is that HRT is only for women with severe symptoms, leading many with milder symptoms to forgo treatment. Additionally, concerns about weight gain, though largely unfounded, have also contributed to reluctance. These myths have resulted in hesitation among both women and healthcare providers, limiting the use of a therapy that could greatly benefit those struggling with menopausal symptoms.

Personalized Approach to HRT

The decision to use HRT should be personalized, taking into account the severity of symptoms, overall health, and individual risk factors. It’s essential for women to have open discussions with their healthcare providers to weigh the benefits and risks of HRT and to consider alternatives if HRT is not suitable.

Are hormones right for every woman? No. Should they be discussed with every woman? At a bare minimum, yes.

Whether you are currently going through menopause, coming up on it soon or not so soon, or even recently postmenopausal we are now better equipped to have a more enlightened conversation.

If you are a current Hometown Family Health member and want to have this conversation, please reach out. We feel so strongly about the topic that we are now also opening those conversations to women beyond just Hometown Family Health members. If you have friends, family, or others who could benefit from these conversations direct them to our website for more information.