Welcome to Menopause Mondays®, where we equip you with the latest information on menopause so that you can make informed healthcare decisions without fear clouding your judgment.

In a groundbreaking paper published in the Clinical Expert Series for the American College of Obstetricians and Gynecologists, Dr. James Simon and Dr. Barbara Levy set out to educate gynecologists on the evolving landscape of hormone therapy (HT). Shockingly, studies reveal that a staggering 80% of gynecologists lack proper education on menopause during medical training, potentially leading to misguided treatment decisions.

In an effort to illuminate this critical issue, I contacted Dr. Simon for further insights into the paper’s findings. So, grab a cozy chair and settle in, because this Menopause Mondays® is about to delve deep.

The paper meticulously traces the history of hormone therapy, examining its journey through scientific understanding regarding risks, benefits, administration methods, dosing, safety considerations, and efficacy. Yet, despite advancements in research, many healthcare providers remain hesitant to prescribe menopausal hormone therapy, often relying on outdated information such as the misinterpretation of the Women’s Health Initiative (WHI) study from 2002.

Consider this analogy: if you were faced with a heart attack, would you want treatment based on two-decade-old knowledge, or would you opt for the latest advancements in emergency care? The same principle applies to menopausal healthcare—it’s time for all providers to catch up with current science.

Is All Hormone Therapy Created Equally?

Dr. Simon emphasizes that NOT all hormone therapies are created equal. Recent scientific revelations have underscored the importance of distinguishing between bioidentical and non-bioidentical hormones, such as estradiol versus conjugated equine estrogen and micronized progesterone versus medroxyprogesterone acetate. These distinctions are crucial as they impact both efficacy and safety profiles.

Can You Clarify the Breast Cancer Risks of HT?

Addressing concerns surrounding breast cancer risks associated with hormone therapy, Hodis and Sarrel, in a 2018 review, critically evaluated the breast cancer risk through the lens of the WHI study. Here is what they found out:  Conjugated equine estrogen combined with medroxyprogesterone acetate in the typical postmenopausal population had a null effect on breast cancer risk. Participants in the study who used menopausal HT prior to entering the study and discontinued it before being randomized to placebo had an UNUSUALLY LOW breast cancer incidence, making similar study subjects randomized to active treatment APPEAR to have a higher risk.  The average woman in the WHI and on these non-bioidentical hormones also had a host of other risk factors, including obesity, low physical activity, and drinking 2 glasses of wine a day! All of these confound the study’s results for otherwise healthy women.

It is important to point out that in the follow-up 18-year study of the WHI, 10,739 post-menopausal women who had a hysterectomy and, therefore, did not need progestin (in this case medroxyprogesterone acetate) had a 45% statistically significant reduction in breast cancer mortality. In addition, even the conjugated equine estrogen plus medroxyprogesterone acetate had a null effect on both breast cancer incidence and breast cancer mortality.

Oh, there’s more ———- Another study, The Nationwide Finnish Comparative Study, found that women using bioidentical estradiol oral pills, transdermal patches, or gels compared with a group not using hormones had a statistically significant reduction in breast cancer mortality.

Furthermore, emerging evidence highlights the potential cardiovascular benefits of hormone therapy when started early after the last menstrual period, overturning previous apprehensions. Studies like the Danish Osteoporosis Prevention Study (DOPS) and the Kronos Early Estrogen Prevention Study (KEEPS) provide valuable insights into the role of hormones in preserving cardiovascular health.

How About the Risks of HT and Cardiovascular Disease?

Various studies on hormones and cardiovascular diseaseexist —the Danish Osteoporosis Prevention Study (DOPS), the Kronos Early Estrogen Prevention Study (KEEPS), The Early Versus Late Postmenopausal Treatment with Estradiol Study (ELITE), and a large case study from a health maintenance organization in the Pacific Northwest. I asked Dr. Simon to explain it to us in layperson speak.

He said, “Hormone therapy started in early menopausal women, typically within 6 years of the last menstrual period, provides cardiovascular risk PREVENTION. It’s generally beneficial for cardiovascular risk. This is likely true for lower cardiovascular risk women (non-smokers, healthy body weight, normal blood pressure, normal cholesterol, etc.).”

Is Local Estrogen Therapy Safe?

In discussing topical and low-dose vaginal estrogen therapy, Dr. Simon reassures patients and oncologists alike of its safety, even for those with hormone-sensitive cancers, including breast cancers.

What is the Impact of HT on Prevention?

It’s tragic to overlook the preventive potential of hormone therapy in osteoporosis prevention, treatment of vasomotor symptoms (hot flashes), and prevention of cardiovascular disease.  Dr. Simon advocates for a balanced approach, emphasizing the importance of offering women the most effective therapies to address their well-being.

Dr. Simon’s tireless efforts in debunking outdated misconceptions and championing accurate information are invaluable in ensuring that women receive the care they need and deserve. You can contact Dr. James Simon at IntimMedicine Specialists, and the good news is that he’s available for virtual appointments!

Thank you, Dr. Simon, for your unwavering commitment to advancing women’s healthcare.

My Motto: Suffering in silence is OUT! Reaching out is IN!

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