Jan 01, 2020 Cassie Tomlin
The menopause symptoms hot flashes and night sweats strike about 80% of women—and can last more than a decade.
Additionally, nearly half of the 50 million menopausal women in the United States suffer from vaginal dryness and changes that can lead to sexual discomfort and increase the risk of getting urinary tract infections. Though both hormonal and nonhormonal therapies can safely and effectively improve vaginal health, one study found only about 11% of women who sought help from physicians found it.
But menopause is more complicated than its wretched side effects: The dramatic decline in estrogen, which happens to most women around age 51, changes the body in ways that are still not fully understood—by women or doctors.
We know that menopause coincides with a rise in a woman's blood pressure and bad cholesterol, which increases heart disease risk. We know that during the first year of menopause, bone density dips drastically, putting women at risk for osteoporosis. But only recently have we begun to understand the connections between menopause and depression, dementia, Alzheimer's disease and sexual health.
"Often we think of menopause as simply the end of a woman's periods, but it's really a systemic and global change throughout the whole body," says Jessica Chan, MD, assistant professor of Obstetrics and Gynecology, who specializes in reproductive endocrinology.
"We know menopause impacts patients' quality of life, but we don't know to what extent we could be helping them get through it," she adds. "We need more dedicated research so we can take care of women as they transition—not just ease their symptoms, but improve their long-term health."
Chrisandra Shufelt, MD, director of the Women's Hormone and Menopause Program, a specialized clinic in the Barbra Streisand Women's Heart Center at the Smidt Heart Institute, says our collective understanding of menopause is still recovering from the confusion that arose over the course of a decade about the risks of menopause hormone therapy. Physicians are beginning to recognize that women deserve individualized treatment for their concerns, "to treat the right symptoms at the right time," she says.
"Menopause is not just about the reproductive system," she says. "The symptoms can be different in every woman, and they're vast and impact probably every area of our bodies. It's not terribly surprising that if doctors are confused about menopause, patients are going to be confused about menopause."
Hormone replacement therapy (HRT)’s reputation has undergone dramatic ups and downs on the way to becoming the standard treatment for menopause symptoms. Here, a brief history.
The Food and Drug Administration (FDA) approves estrogen hormone therapy to treat hot flashes and night sweats.
Feminine Forever, by Robert Wilson, MD, claims that menopause is a "totally preventable" estrogen deficiency, spurring a rash of estrogen prescriptions so women will be "much more pleasant to live with” and “not become dull and unattractive."
The long-term Coronary Drug Project clinical trial on the effects on men (and only men) who previously suffered heart attacks is stopped early, noting that men taking estrogen have more heart attacks and blood clots.
The National Institutes of Health launches the Women’s Health Initiative, the first clinical trial aiming to determine if HRT prevents chronic conditions, including heart disease, in postmenopausal women.
Prescriptions for HRT plummet by 80%. Women’s Health Initiative investigators reanalyze their findings to conclude that women who start HRT within 10 years of the onset of menopause did not have increased risk of coronary artery disease.
Studies show that women’s heart disease spikes at around menopause, leading to the accepted hypothesis that low estrogen is to blame for heart disease.
Two studies in the New England Journal of Medicine find that estrogen alone increases endometrial cancer risk. FDA recommends estrogen plus progestin for women who still have a uterus.
Several observational studies show that women taking estrogen suffer fewer deaths from heart attack and blood clots. HRT becomes the country’s most prescribed category of drug.
The Women’s Health Initiative publishes its results, causing panic about HRT. The trial is stopped three years early because women who began taking hormones 10 years after menopause suffered increased risk of breast cancer, heart attack and blood clots.
The North American Menopause Society publishes an updated position statement calling HRT the most effective treatment for hot flashes and vaginal symptoms when prescribed in healthy women at the onset of menopause.