The Fall of Myths about Menopause: New Treatment Opportunities Benefit Women

Until recently, it was believed that older women, especially those over 65, should not receive Hormone Replacement Therapy (HRT) because they were supposedly no longer presenting menopausal symptoms. However, many women continue to suffer symptoms such as “hot flashes” even after more than 10 years since the onset of menopause.

A recent study, published in the journal Menopause, reignited the debate over the appropriate duration for the indication and maintenance of hormonal therapy in menopause.

The researchers analyzed records of approximately 10 million women over 65, from 2007 to 2020, comparing mortality rates, the incidence of five types of cancer (including breast cancer), cardiovascular events, and dementia between women who did not receive HRT and those who continued treatment over the 14 years of observation.

Compared to women who never used or discontinued hormonal therapy after 65, isolated estrogen use was associated with significant reductions in mortality (19%) and in the risk of breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%). On the other hand, the combination of estrogen with progesterone increased the risk of breast cancer (from 10% to 19%), although this risk was reduced with lower doses and vaginal and transdermal routes were preferred. The association with progesterone was linked to significant reductions in the risk of endometrial cancer (45%) and ovarian cancer (21%). The isolated use of progesterone was also associated with a 10% reduction in the risk of breast cancer.

Interestingly, during the 14 years of the study (2007-2020), the number of women receiving HRT decreased by half, likely reflecting the impact of studies like the WHI and others on doctors and patients. A change in the type of replacement prescribed was also observed, with conjugated equine estrogens being replaced by 17 Beta estradiol and a reduction in the use of the oral route. A significant finding was that the number of women who only use estrogen replacement is 10 times greater than the number of women who undergo combined therapy with estrogen and progesterone.

It is evident that the implications of Hormone Replacement Therapy for women’s health are strongly linked to the type of hormone, dosage, and routes of administration. In general, risk reductions seem to be greater with lower doses, favoring vaginal or transdermal formulations rather than oral routes. In this regard, recent technological advances in the area of hormonal replacement have enabled the safe use of this therapy.

In my opinion, hormonal implants allow for a personalization of hormonal treatment, which is especially important for women over 65, offering physiological doses with continuous release and avoiding the fluctuations associated with daily use formulations.

As the authors of the study suggest, the decision to start or maintain hormonal therapy after 65 should consider the risks and benefits, taking into account each woman’s specific health conditions. However, there is no general recommendation to discontinue HRT in these women.

Summary of a study published in the prestigious journal “Menopause” conducted by Dr. Francisco Tostes, a specialist in hormone therapy with implants and Scientific Director at Renewal.