Hormones May Help Younger Women With Menopause Symptoms

For Linnea Duvall, a marriage and family therapist who lives and works in Santa Monica, Calif., the symptoms of menopause started when she turned 50. She felt more irritable and a smidge heavier, and she started waking up two to three times a night. And then she had a hot flash.

"It felt like a nuclear bomb went off right behind my belly button," she says. "The radiation went out to my fingertips, the tops of my toes, the top of my head and the ends of my hair."

But Duvall would not consider hormone therapy to control the flashes. She was terrified. She says she can sum up her fear in two words: "breast cancer."

To understand why she feels this way, we have to look back a few decades to a time when many postmenopausal women were taking hormones to treat symptoms. At the time, hormones were thought of as something of an elixir of youth that could also prevent chronic disease. So women took hormones indefinitely. But a huge study in 2002 changed everything.

Known as the Women's Health Initiative, it found that taking estrogen plus progestin hormone replacement therapy actually increased a woman's risk of heart disease and breast cancer. The study had a huge effect. Within months the number of women taking hormones in the U.S. dropped by almost half. Today, only about 10 percent of women ages 50 and over are on hormone therapy.

That was a huge overreaction, according to Dr. Wulf Utian, director of the North American Menopause Society, particularly in light of more recent findings. A more detailed analysis of the Women's Health Initiative data found that age really made a difference in heart disease risk. For women who started hormone therapy between the ages of 50 and 59, there was a protective benefit, says Dr. JoAnn Manson, one of the lead investigators of the study and a professor of medicine at the Harvard T.H. Chan School of Public Health.

Women who take hormones earlier after the onset of menopause may experience less plaque, blood vessel blockage and atherosclerosis, Manson says, and possibly even a reduced risk of heart attack. But for women over the age of 60, the benefit seems to disappear. This is probably because older women already have plaque buildup, Manson says.

Researchers in Denmark also found that age makes a difference. They looked at 1,000 healthy women between the ages of 45 and 58. The women who took hormones experienced significantly reduced risk of mortality, heart failure and heart attack.

Today, menopausal women are young in the scale of things, says Dr. Utian, noting that menopause typically starts between age 45 and 60. If women start hormones within a few years of menopause or even a few years before, he says, there are numerous benefits beyond controlling hot flashes. These benefits include reduced risk of bone fractures, reduced risk of diabetes and, for many women, an overall boost in their quality of life — meaning better sleep, maintenance of libido and more comfortable sex.

"In my opinion, the best recommendation would be for some form of hormone therapy," says Utian.

But here's the worry. Studies do confirm an increased risk of breast cancer among women taking hormones, regardless of age. Manson says any risk is worrisome, but it's important to put this risk in perspective and understand that it is actually small.

"For every 1,000 women per year not using hormone therapy, about three would develop breast cancer," Manson says. "And among every 1,000 women using hormone therapy, about four of them would develop breast cancer, so that's about one extra case of breast cancer per 1,000 women per year on hormone therapy."

This is where things get tricky. There is no consensus in the medical community on whether the symptom relief is worth the extra risk. Different doctors interpret risk differently. And if you're a breast oncologist like Dr. Rowan Chlebowski at Harbor UCLA Medical Center, any risk is too much.

"It's a disease that I see every day," Chlebowsi says. "So I think that's something to be avoided."

Chlebowski adds that hormone therapy also makes it more difficult to read mammograms, since hormones make the breast denser. If mammograms are more difficult to read, it's harder to diagnose breast cancer in its earliest stage when it's most treatable.

So bottom line — this really is an individual decision between a woman and her doctor, a decision based on how much risk a woman can tolerate in favor of symptom control and other potential benefits. Researcher Joann Manson says if a woman chooses hormone therapy, then the lowest possible dose for the shortest amount of time is probably safe for most women.

Menopause and Hormones

Hormones play a role in almost every function of our bodies. Think of them as biological messengers, telling tissues what they should do and when. Estrogen is one hormone that almost all women have heard of but may not fully realize how and why it’s needed. Especially when reaching perimenopause, estrogen becomes a familiar term - in more ways than one. While estrogen is present in both females and males, for the purpose of this article we’ll be concentrating on its role for women. What Is Estrogen?

Estrogen is a vital hormone provided by the ovaries and, in the case of pregnancy, also produced by the fetal-placental unit. It plays several different, important roles in a woman’s life, depending on her age.

When a female reaches puberty, the ovaries begin to release estrogen with each menstrual cycle. It’s also likely to be one of the reasons she experiences the mood disturbances that come with premenstrual syndrome (PMS). Estrogen serves to help regulate the menstrual cycle, trigger ovulation, and create a productive environment for fertilization and pregnancy. Estrogen also affects body shape, body hair, voice pitch, bone formation, vaginal PH levels that protect against bacteria, blood flow to the uterus, contractions during delivery, breast growth, and more.

Estrogen’s Role In Menopause

Perimenopause (the two to eight years leading up to menopause) is brought about by erratic estrogen levels. The fluctuation of estrogen (varied ranges of high production and deficiency) causes both physical and emotional changes such as hot flashes, depression, irregular menstruation, headaches, loss of libido, and mood swings.

Eventually, the ovaries stop releasing eggs. At this point menstruation ceases. When a woman has gone 12 consecutive months without menstruation, she is considered officially menopausal.

Unfortunately, lack of estrogen may continue to cause issues after this point. Symptoms such as hot flashes and mood swings can continue for some time. They may even be worse or better due to the fact that, unlike perimenopause, you no longer have any ups and downs since your body is now producing much less estrogen. Replacing the missing estrogen in the body with medication can help relieve many of these discomforts.

The Benefits of Estrogen Treatment

Estrogen Replacement Therapy (ERT) comes in several different forms and methods but with the same goal: replenish the hormone that is missing from your body so the areas affected by the deficiency can resume normal, balanced function. In a nutshell, so you can feel like yourself again.

Estrogen treatment comes in four primary methods:

• Oral pills - Taken once per day, pills are the most common form of ERT.
• Skin patches - Available with estrogen or estrogen combined with progestin, patches are worn on the stomach and changed once or twice per week.
• Topical cream, gel or spray - Like patches, these methods allow the estrogen to absorb through your skin and enter into your bloodstream. They are typically applied once per day.
• Suppositories, rings, and vaginal creams - These methods involve administering the hormone directly to the vaginal area. It is especially beneficial for women who’ve experienced severe vaginal issues such as dryness or pain during intercourse. These therapies are required to be administered anywhere between daily to once every several months, depending on the method chosen.

Sexual desire as Important in Elders

A new study by University of California researchers, just published in the journalPsychology and Aging, surveyed 5,500 users, aged 20-95, of the dating site eHarmony and found that desire was considered just as important as companionship by those aged 60 and over. It’s not the first, nor will it be the last, piece of research to find that sexual desire doesn’t expire. But what’s interesting is that this has to be rediscovered again and again, as though it so contradicts the dominant narratives around both ageing and sex that we somehow can’t believe it.

Our thinking about sex has been so colonized by the gymnastic model – all acrobatic contortions, supposedly inimical to arthritic hips and dodgy knees, that the finding simply seems counterintuitive. The old saw about the most erogenous zone being between the ears is buried when this kind of position-speak prevails.

Then there’s the presumption that desire thrives on, even demands, novelty, as if it were some transnational corporation that needs to come up with ever-changing products to keep us interested (hence the cliche about passion inevitably declining in long-term relationships). We undervalue, perhaps, the experienced lover, as against the rookie. Certainly, enshrined in the idea of the asexual old are some pretty dubious stereotypes. It appears that sexual desire is too fierce an emotion to reconcile with the caricature of old age (don’t get yourself too excited, dear, you’ll have a coronary).

It’s all part of the pastel-isation of old age, the notion that when the hair goes grey so does the emotional palette: that advancing age requires a winceyette nightdress and mug of cocoa, a companion (a word that carries a whiff of the commode) not a lover.

Wrinkled old bodies are often described as though they were inherently repellent. While women are particularly vulnerable to this kind of disgust and often internalise it, the sexually active old man is also the subject of jokes and distaste, regarded as either an inadequate Viagra needer or a dirty old man.

How ill-served men – and women – have been by the hydraulic view of male sexuality: sex as mechanics, pressure, angles.

In reality, and despite cultural differences, sexual desire for many (but not all) is a basic human appetite: while some people may grow less interested in, say, food as they grow older, or eat less, we wouldn’t therefore assume that old people in general don’t get hungry or enjoy eating.

Indeed old people often report a craving to touch and be touched. Though there are many other, non-sexual ways that can happen, sex is a pretty good one. But this has proved particularly problematic in the more paternalistic care homes where any hint of sexual congress between residents is frowned upon.

Indeed, many older people’s reactions to the new study will be a frank “if only”. It’s lack of opportunity and not desire that they rue. The new study is based on users of a dating site, and it’s conceivable that the older people using these are a touch racier than the rest of their age cohort. Yet where’s the evidence that long-term relationships inevitably get less sexy? Might it not be the case that when men become less sexually impatient and women more sexually assertive, when a couple get to know each other’s needs and bodies better, the sex – while different – can get more and not less erotic? Or, when there’s no need for contraception, or no prospect of children wandering in, at any rate less anxious?

We know that the experience of ageing is changing. The current cohort of older people came of age sexually in the 1960s – they’re the generation of the pill, gay liberation and so on. Caitlyn Jenner, new trans poster woman, is 66. Polymorphous sexuality isn’t the preserve of the young.

It would be a pity if successive findings that desire doesn’t necessarily decline with age are used as another edict – you must keep at it – to add to all the other punitive norms about “good ageing”.

Some men, and women, are only too pleased to be rid of the whole business. But then, this applies to people of all ages.