Hormone Replacement Therapy: Better Than Your Reputation?

Experts call for a turnaround in the treatment of menopausal symptoms

Around 70 percent of all women suffer from hot flashes during menopause. © Highwaystaz-Photography / thinkstock
Read out

But not as dangerous as thought: The hormone replacement therapy for the treatment of menopausal symptoms was long considered risky. However, recent data suggest that therapy may be better than their reputation. Therefore, experts are calling for a rethink: women with menopausal symptoms should receive hormone treatment more frequently. In order to avoid risks, the timing and duration of the therapy are of primary importance.

Rarely, the benefits and risks of medical treatment are as controversial as with hormone replacement therapy. Initially, the treatment was designed to help women relieve the onset of menopause and relieve associated symptoms such as hot flushes, sleep disorders, dizziness or depression. At the same time experts in hormone therapy have a protective effect against, for example, cardiovascular diseases and bone loss.

However, when the US National Institutes of Health published the findings of the Women's Health Initiative (WHI) in 2002, the treatment suddenly fell into disrepute. The actual 15-year study looked at the effects of hormone therapy on the health of 16, 000 women and was discontinued after five years. The reason: In the study group, which had received hormones, it had come to significantly increased rates of breast cancer, stroke, thrombosis and heart attacks.

Hormones, for example, in tablet form, can relieve menopausal symptoms - but have a bad reputation. © Artisteer / thinkstock

Controversial interpretation

After the publication of the study, the regulation of hormones decreased significantly. To date, many women are worried about this form of therapy. Therefore, doctors are increasingly trying to treat typical menopausal symptoms with alternative remedies and are using antidepressants or sleeping pills, for example.

However, there is also a long line of criticism regarding the interpretation of the data in the WHI study. At that time, it was not considered that the average age of women in this study was comparatively high at 63 - a decisive factor. Most recently, studies have shown that the benefits and risks of hormone treatment are age-dependent and that early onset may mean fewer health risks. display

"In addition, the participants were on average obese and had metabolic diseases such as diabetes, lipid metabolism disorders and increased blood pressure: they were not healthy, " says Cornelia Jaursch-Hancke of the Helios Clinic in Wiesbaden.

"Withheld effective treatment"

Recent data from Denmark and a re-evaluation of younger women in the WHI study now suggest that hormone replacement therapy may be better than their reputation. Thus, early hormone treatment in menopause can not only treat the symptoms effectively, but can even have beneficial effects on the cardiovascular system and the death rate. In addition, a single estrogen therapy seems to be usually only given to women who no longer have a womb to reduce breast cancer risk.

Experts from the German Society of Endocrinologists (DGE) are calling for a rethinking of hormone therapy in light of these findings. "Millions of women have been deprived of a meaningful and highly effective treatment for menopausal symptoms, " says Jaursch-Hancke. Instead of treating the cause, ie the estrogen deficiency, the therapy remained at the level of the symptoms. That has to change now.

Five years as the right time span

Although the experts emphasize that many women experience the phase of life of menopause well and satisfied even without hormone treatment and that therapy should not generally be offered to every woman. "About 20 to 30 percent of women, however, do have severe discomfort. We can now help these women with hormone therapy with a clear conscience, "says Vice President DGE Sven Diederich.

Despite all the positive effects of hormone therapy may be associated with risks - that is not disputed by the doctors. For example, there is a slightly increased risk of thrombosis, which can be minimized by a suitable application form, for example via the skin. It is also important to talk to the attending physician about the duration of the therapy: "Five years of hormone therapy is the right amount of time with regard to possible risks, " says Diederich.

"It is also important that you then escape this therapy and accompany the patient. Otherwise, the unpleasant complaints are back soon, which can then motivate them to carry out a permanent continuation, which we should avoid because of the more negative data available from longer-term treatment and over 60-year-old women. " Risk for breast cancer has a hereditary disposition much to do with overweight and lack of exercise. This is what women should pay attention to and, moreover, carry out the regular screening tests, the researcher concludes.

(Association of Scientific Medical Societies, 29.08.2017 - DAL)