Hormonal choices

Johanne Erickson could handle two to three hot flashes a week when her perimenopause symptoms began two years ago, when she was 44.

But by February, 40 to 50 hot flashes a day plagued the Oxford, Mich., woman.

Erickson, a human resources manager for an automotive supplier, turned into the office joke. Friends bought her a cache of fans.

“At some point you either have to laugh about it and have a sense of humor, or otherwise you jump out the window,” she says.

The situation led Erickson to start hormone therapy – a $2.2 billion industry – despite risks of breast cancer, heart disease blood clots and stroke indicated in research in the early 2000s.

For women like her, the pendulum of hormone-therapy treatment is swinging once again. It’s offering relief to those struggling with hot flashes, night sweats, insomnia and mood swings as they leave their reproductive years in their 40s and 50s.

Since she began taking nonsynthetic hormones, Erickson’s hot flashes are gone and she’s begun sleeping better.

“You have to weigh your quality of life,” she says. “Is this something I’d consider staying on the rest of my life? No. But is it something I’m willing to consider for a year or two? Yes.”

Menopause – a woman’s last menstrual cycle, and the end of her fertility – occurs, on average, at age 51. But the transition phase, called perimenopause, can last six years or more, with myriad symptoms.

Gone are the days when doctors doled out prescriptions for oral estrogen and progestogens, telling women that replacing their naturally dwindling hormones would do everything from stop their hot flashes and mood swings to combat wrinkles and prevent late-age health issues.

Many women stopped taking hormones in the early 2000s, scared after National Institutes of Health researchers abruptly halted a Women’s Health Initiative study that indicated some hormone therapies can increase the risk of breast cancer, heart disease, blood clots and stroke.

“There have been a lot of updates” since that study, says Detroit Medical Center Dr. Susan Hendrix, a clinical professor of obstetrics and gynecology at Michigan State University and a principal investigator for the study.

The Journal of the American Medical Association’s April 6 issue reported that another branch of the study continued through 2009 and found that women who had a hysterectomy and who used estrogen did not experience many of the health risks. The study also showed that those women saw a decreased risk of breast cancer.

Dr. Margery Gass, executive director of the North American Menopause Society, says the use of hormones to treat symptoms of menopause has evolved with ongoing research.

Before the National Institutes of Health study, “they were telling women to take them forever, and that’s changed,” Gass says. “Basically (now) it’s using them for a reason, and using the lowest dose that treats the symptom.”

Hendrix says women sometimes turn to bioidentical, or nonsynthetic, hormones – a treatment touted by actress Suzanne Somers – thinking they’re safer. But she thinks the difference doesn’t affect the risk of disease.

“They’re all still binding to the same receptor in a woman’s body, and they all have the same effect,” Hendrix says.

One of the relatively new ways to deliver hormones is with transdermal skin patches, which have not been studied long-term but may reduce the risk of blood clots.

Virginia Reader, 72, of Orion Township, Mich., started taking hormones in pill form at age 48, after dealing with hot flashes and not feeling like herself. Then her doctor suggested patches, and she has used them for seven years.

Reader’s doctor, obstetrician-gynecologist Luana Kyselka, says researchers now realize that the original studies looked at mostly women older than 60 who may have already been predisposed to late-life disease, rather than those first experiencing symptoms in their late 40s and early 50s.

“We have this window of opportunity to use hormone therapy without as much risk as we thought,” Kyselka says, adding that more recent research has shown that women who begin hormone therapy within months of first experiencing the symptoms of menopause, or who use low-dose estrogen/progestogens, may not be as at risk.

Though Reader is now in her 70s, she started hormone therapy in her younger years and says to her, it’s worth the risk.

“I feel so good, and I think that has a lot to do with it,” she says. “This is about women taking charge of their choices.”