A question of hormones
In 2002, the media reported that findings from the Women’s Health Initiative — a large study researching hormone therapy (HT) — suggested HT increased the risk of heart disease and stroke. Wall Street Journal columnist Tara Parker-Pope makes a compelling argument in her recent book, The Hormone Decision, that the public didn’t get the full story.
What’s your biggest frustration with the way the scientific community has treated menopause?
What bothered me most was this way of looking at women like we were just body parts. There seemed to be a real lack of understanding about menopause. The most important issues for women and doctors just were not considered or discussed. You have a generation of women who have been misled about the risks and benefits about this treatment option. We need to realize that studies are important, but you can’t forget that menopause is a complex process and that women are just as complex.
What are the main misconceptions surrounding HT since the WHI?
When the results were first announced, public perception was that hormones were risky for all women and that those risks outweighed the benefits. The reality is that the WHI was a study of older women — not of 45- to 50-year-olds with symptoms who could consider hormones a viable treatment option. It was a study to determine if hormones could provide heart protection to women ages 50 to 79. The study was stopped because of a higher risk for heart attack and breast cancer in older women using hormones, but the bottom line is that younger women seem to get distinct benefits — heart protection for one — from the treatment, and that the serious risks are very low.
How do you know if hormone therapy is right for you?
If you have hot flashes or any other disruptive symptoms causing you distress, then you’re a candidate. If you’re one of those fortunate women who can just glide through it, there’s no reason to think about taking a pill. I think the bottom line of this study is that it’s risky to start hormones if you are long past menopause.
When is it time to stop taking hormones?
For some women taking hormones, their symptoms taper off after a few years. For others, symptoms come back with a vengeance once they go off hormones. Nobody wants to take a pill for the rest of her life. The women who taper off and still have problems have to decide if they want to go on a lower dose. They shouldn’t be made to feel like their making a bad choice if they choose to continue treatment. The FDA recommendation is the lowest dose for the shortest possible time. It’s a conservative recommendation that works for most women. But at middle life, you have so much going on, and having a hot flash in a board meeting, for example, is sometimes just not an option. It’s not just about your body; it’s about your life. If you’re taking care of an aging parent and you can’t sleep because of hot flashes, your choice might be different than a woman who can sleep late.
How do you feel about the argument that menopause is a natural process that shouldn’t require medical intervention through hormones?
To those who say menopause is natural, I say, so is having 10 babies. Women avail themselves of medical technology, including hormones, throughout their lifetime: epidurals, the Pill, pain relievers, for example. Why do the rules change in menopause? The technology is there for you if you need it. It’s not an affront to nature.
What should we keep in mind when reading the next medical headline?
No study can tell you what the best choice is for you. Consider all the facts, and your own personal history. If osteoporosis is a big issue for you, you have a different decision to make than if you’re at risk for breast cancer. It’s all about your individual health history and your priorities.
Why did you write this book?
When the results of the WHI came out, there was a lot of confusion and concern. I’ve been following the story for five years and a lot of what was reported was unclear. Menopause is such a meaningful life transition, and the symptoms can affect your relationships, job, and overall happiness. I think throughout history, medicine has been patronizing to women, but the info and facts are there.
This article originally appeared in the October 2007 issue of More
