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Is Hormone Therapy Really Necessary in Menopause?

Do Women Really Have To Suffer?

Last week I wrote about why strength training is so beneficial when we start transitioning to and reach menopause. You can read that post here. In this post I am addressing the next question, which was,


Question #2: why do we need hormone therapy in the first place? 

Isn’t that trying to prevent nature from taking its course, and trying to stay forever young? Shouldn’t it be possible to age gracefully and healthfully without trying to replace our hormones?

That is also an amazing question. And I believe that this question also stems from a myth: that women are meant to suffer. !!!


(if you want to skip the rant about where this belief comes from, skip to the question repeated below)


But before I address why some women may benefit from hormone therapy, I want to start with the disclaimer that I am not a medical or a health practitioner. I am a health researcher and a fitness trainer. But I read a lot of research and combine this with my own and others' experiences, and try to translate this in simple terms for everyone to understand. You should seek guidance from a qualified healthcare provider, and hopefully the explanation I provide can help you better formulate your own research and questions you bring to your provider, and help inform your healthcare decisions.


Women in Health

There are a lot of myths and misconceptions when it comes to hormones, and especially menopause. Even women's health. There is this societal and cultural belief that women's bodies are complicated and naturally meant to experience suffering. Take as examples girls who reach puberty and have painful periods. Many suffer their whole lives without adequate help or explanation for why it's happening in the first place.


Then, women get pregnant, and those can get problematic. That is, if they're able to. If they seek fertility treatments, we subject them to painful and invasive procedures like egg retrievals, etc. Again, not much in the way of explaining why women get pre-eclampsia or gestational diabetes or other autoimmune problems during pregnancy or are more prone to miscarriages or hemorrhaging.


In birthing, women are at risk of dangerous complications, including death, but at the very least painful labor, tearing, and other traumatic events, such as getting their cervix cut out (!!!). Not to mention pelvic floor dysfunction for years down the road.


And then, as if that wasn't enough, women then have to go through a decade long and sometimes longer transition period to no longer having periods, which you would expect, with the nightmare that they brought for many women, would be a relief. But no, for many women this is the worst period of their lives, with problems like insomnia, weight gain, depression and anxiety, anger, rage and disillusionment, hot flushes, panic attacks and heart palpitations, loss of libido (is it any wonder, with everything else going on?) and intimacy challenges, skin problems (dry skin, acne, eczema/psoriasis), digestive problems, headaches, vertigo, loss of memory and focus, joint pain, you name it.


And the worst part? Menopause is "funny". Women fanning themselves is a joke and a meme all over the Internet. Women's forgetfulness and loss of interest in sex is laughable.


And the second worst part? When women bring this up with their doctors (if they do - research shows less than half of women actually seek healthcare treatment for their menopause symptoms), many are dismissed and not helped due to lack of training by their doctors, or worse, told this is just part of the menopause transition experience and is "normal", but it's temporary, so just suck it up, buttercup. !!!


Do you understand why women don't trust doctors? or don't talk about their menopause at work and to their neighbors and friends? Because our culture doesn't take our very real and dramatic experiences of menopause seriously. Or of being a woman, period. (no pun intended). Perhaps because suffering has been viewed as normal since historic times, little to no research has been done to date on women-specific symptoms and conditions, such as endometriosis, fibroids, painful periods, MS, lupus, etc.


Internalized Attitudes

At the same time, there is this attitude among women that we are resilient and strong. And while this is true, this is then internalized by women that we have to suffer without complaining. We have to do things "naturally" even if it hurts, because we are naturally designed to suffer. And if we seek relief from the pain and suffering, then we are weak and not worthy of being a real woman. I noticed this when I was pregnant, and I guess this same way of thinking translates to expecting a natural menopause transition even if it's miserable, because suffering is "natural" and expected as a woman.


I would propose that in Judeo-Christian/monotheist religious societies this comes from the belief of "original sin", where Eve is blamed in the Bible for everything bad mankind has ever done. She "tempted" Adam to take the apple, which was forbidden. (here) And thus, she was punished with painful childbirth (while Adam was simply punished by having to work hard to grow food - funny how men have internalized this as meaning they have to work hard to provide for their families (not exactly "suffering"), and this is viewed positively by society. Whereas women have to literally suffer physically and emotionally to have babies, and this is also viewed positively by society). Elinor Cleghorn describes how women's (mis)treatment in medicine (or lack thereof) comes from ancient Greek beliefs that women's "hysteria" was due to her wandering uterus and that this belief, as ridiculous as it seems to us today, still persists in different forms. Some scholars propose that the Adam and Eve and other similar creation stories greatly influenced this Greek "hysteria" belief that subjected women to such negative stigma for millenia.


So this brings us back to our original question: Is taking hormone therapy a cop out and a sign of weakness? Or is it actually beneficial?


Ok, if we take the medical perspective, which is strictly looking at a symptoms approach, hormone therapy is medically proven to reduce some menopause symptoms (especially vasomotor symptoms, i.e. hot flushes, vaginal dryness and UTIs, and osteoporosis, and to a lesser degree also can help alleviate mood and sleep symptoms). Taking hormone therapy has also been shown to reduce risks of cardiovacular disease, cognitive decline, and arthritis. (here and here)


[This is an important distinction: reducing risk of and treating aren't the same thing. In other words, if you don't suffer from hot flushes but are suffering from arthritis, even though studies show that taking hormone therapy may reduce risk over the long-term of developing arthritis, your doctor likely won't prescribe it for you because it hasn't been studied as an intervention AFTER someone has been diagnosed with arthritis. But if you suffer from hot flushes, and also arthritis, then studies show that if you take hormone therapy you will probably benefit on both accounts.]


Some women breeze through menopause without many symptoms at all. Those seem to be the minority. Some women have a horrible time of it that just seems endless. That's believed to be around a quarter of women. The rest of women are estimated to be somewhere in the middle, experiencing some or moderately severe symptoms or for a shorter duration. The severity of menopause symptoms is multifactorial and not due to any individual factor. Sure, lifestyle plays a role, but so does genetics, previous health history, social determinants of health, childhood experiences, etc. In other words, it's not a woman's fault if she is suffering during menopause.


Above all, context matters. In other words, women in Western societies have more and worse menopause symptoms than in traditional or matriarchal societies, where elder women are revered and honored for their wisdom and knowledge. (here and here) Negative views of menopause are also associated with more menopause symptoms compared to more positive views of menopause. (here)


But once again, as I said in my previous post, hormone therapy isn't a panacea, just like strength training by itself isn't everything. My understanding of the reason that hormone therapy works (when it works) is, as I mentioned in my previous post, estrogen and progesterone are anti-inflammatory. When a woman's body is suffering significantly from her fluctuating and declining hormones, she is probably in a highly inflamed state, and her body is struggling to adapt. Some lifestyle habits don't help such as alcohol, smoking and caffeine, and being sedentary or inoptimally managing stress, and often other pre-existing conditions such as digestive infections or autoimmune or chronic conditions can really mess with the immune system and exacerbate inflammation. Hormone therapy just takes the edge off, and allows the other healthy lifestyle habits to be more effective. For example, research shows that estrogen therapy by itself isn't as effective as estrogen therapy combined with resistance training. (here)


Also, not all women are eligible, or can tolerate it. Back in the day when the risks were understood to be high, there were mostly synthetic hormones available in few formulations, and the studies were done on older women in poorer health (those results have since been debunked). Nowadays there is better research, and many more (many would argue safer) options, for example different routes of administration (oral vs transdermal vs vaginal), different dosages, different formulations (synthetic vs bioidentical), and if you need very targeted doses you can even get it customized for you through compounding (usually via naturopathic doctor or integrative practitioner). But the risks are still considered too high (or still not well-enough understood) in women with certain cancers and other pre-existing conditions. For those women, there are some non-hormonal alternatives like antidepressants, pseudo-hormonal and herbal therapies.


The question remains, once on hormones, do you have to stay on it forever? My understanding of the research so far is that you can do it either way relatively safely, as long as your health is being monitored and guided by a healthcare provider. The only contraindication is that the window of time to start hormone therapy is currently limited to 10 years post menopause - once past this window, the benefits no longer outweigh the potential risks. But once on hormone therapy, if a woman feels good, she can stay on it forever, or she can stop whenever she wants, with limited impact to her health. (No, her symptoms won't necessarily return if she stops).


Once again, I remind you that I am not a menopause expert. I simply do research, and relay my findings to you. You should verify what I say with your own research, and ask a qualified health provider (with the caveat that your doctor or even your OB/GYN may not know. Make sure the health provider you ask has training in menopause, or at least in hormonal health with appropriate credentials such as with the North American Menopause Society.)


Last words

If you're asking yourself whether your suffering is normal, or if you should get help because you are suffering, I encourage you to examine your thinking around your experience of suffering and how you may have internalized age-old messages. The point is, just because you're a woman doesn't mean you have to suffer, and getting help for your menopause - even though it is a natural transition - doesn't make you weaker or less worthy of being a woman. I encourage you to seek help, speak out, and advocate for yourself, regardless of what this looks like. You may be fine with lifestyle changes, herbal therapies, meditation or cognitive behavioral therapy, or you may benefit from additional hormone or other medical therapy. At the end of the day, it's your choice, but make sure you go into that decision-making process well-informed and with awareness of your internalized beliefs. You are worthy of care and ease.


If you need help with identifying and implementing lifestyle changes that could benefit your health and life, reach out, I can help.




Sarah Lussier is a Menopause Health Mediator and Strategist. She teaches strength training and other lifestyle hacks to menopausal women, and guides women in investigating and exploring evidential strategies and navigating healthcare resources to achieve their best health as they transition through menopause and beyond. Explore her services further at www.rootedskysolutions.com, or contact her at sarah@rootedskysolutions.com to book a free session to see how she can best support you.

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