Debunking Menopause Myths: New Treatment Opportunities Benefit Women

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

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

Revolutionary Study Methodology

Researchers analyzed records of approximately 10 million women over 65 years old, from 2007 to 2020, comparing:

Parameters Analyzed:

• Mortality rates
• Incidence of five types of cancer (including breast)
• Cardiovascular events
• Dementia

The study compared women who did not undergo HRT with those who followed treatment throughout the 14 years of observation.

Surprising Results on Estrogen Alone

Compared with women who never used or discontinued hormone therapy after age 65, estrogen-only use was associated with significant reductions:

Mortality and Risk Reductions:

• Overall mortality: 19% reduction
• Breast cancer: 16% reduction
• Lung cancer: 13% reduction
• Colorectal cancer: 12% reduction
• Congestive heart failure: 5% reduction
• Venous thromboembolism: 3% reduction
• Atrial fibrillation: 4% reduction
• Acute myocardial infarction: 11% reduction
• Dementia: 2% reduction

Combined Therapy: Estrogen + Progesterone

On the other hand, the combination of estrogen with progesterone presented mixed results:

Risks and Benefits:

• Increased breast cancer risk: 10% to 19%
  • Note: This risk was reduced with lower doses and preferring vaginal and transdermal routes

Significant Reductions:

• Endometrial cancer: 45% reduction
• Ovarian cancer: 21% reduction

Progesterone Alone:

• Breast cancer: 10% risk reduction

Changes in Clinical Practice (2007-2020)

During the 14 years of the study, important changes in prescribing were observed:

Reduction in Use:

• The number of women receiving HRT fell by half
• Likely reflection of the impact of studies like WHI on physicians and patients

Prescription Changes:

• Conjugated equine estrogens → 17 Beta estradiol
• Reduction in oral route use
• Estrogen alone is prescribed 10 times more than combined therapy

Important Clinical Implications

It is evident that the implications of HRT for women's health are strongly linked to:

Determining Factors:

• Type of hormone used
• Doses administered
• Routes of administration

In general, risk reductions appear to be greater with lower doses, preferring vaginal or transdermal presentations instead of the oral route.

The Revolution of Hormonal Implants

In this regard, recent technological advances in hormone replacement have made the safe use of this therapy viable.

Implant Advantages:

In my opinion, hormonal implants allow:

• Personalization of hormonal treatment
• Especially important for women from age 65
• Physiological doses with continuous release
• No fluctuations associated with daily-use presentations

Clinical Recommendations

As suggested by the study authors, the decision to initiate or maintain hormone therapy after age 65 should consider:

Evaluation Criteria:

• Individual risks and benefits
• Specific health conditions of each woman
• Persistent menopausal symptoms
• Patient's quality of life

Important: There is no general recommendation to discontinue HRT in these women.

Conclusion

This revolutionary study with 10 million women demonstrates that many myths about menopause need to be revised. HRT after age 65 can be not only safe but also beneficial when appropriately prescribed and monitored.

The individualization of treatment and the use of advanced technologies such as hormonal implants open new possibilities to improve the quality of life of postmenopausal women.

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Summary of a study published in the renowned journal "Menopause" by Dr. Francisco Tostes, specialist in hormone therapy with absorbable implants and Scientific Director of SottoPelle Brasil.