Editor's note: Dr. Streicher is a clinical professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University and medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. Here, she tackles some of the common questions and concerns she hears from women about taking hormone therapy after menopause.
Q. I have terrible hot flashes and I was going to wait it out, but it has been two years and I am still up all night. I am thinking about starting estrogen, but I am worried about the risks. Is it safe?
The short answer is yes, for most women estrogen is safe. Statistically, you probably have at least another five years of flashes, which means another five years of sleep deprivation, so toughing it out is not a great option.
There are two main things women want to know before they jump on the post menopause estrogen bandwagon:
Q. Is estrogen going to cause a blood clot?
Anyone can get a blood clot, but it is true that there is a small increased risk of blood clots in women who take ORAL estrogen — meaning in pill form. However, there does not appear to be an increased risk of blood clots in women who use a transdermal option — meaning a patch, cream, spray or gel that delivers estrogen through the skin.
But even with an oral estrogen, the risk is small. In the 2002 Women’s Health Initiative Study, the study that caused all the concern, there were only 18 additional blood clots for every 10,000 women per year in the estrogen group. That's less than 1%. Interestingly, most mid-life women are far less fearful of birth control pills, which have a significantly higher strength of estrogen.
Q. Is estrogen going to cause breast cancer?
In women who are 50-60 years old and who use estrogen — the most likely group to use estrogen since that's the age range when hot flashes are the most intense — there is actually a DECREASED risk of breast cancer.
The slight increase in breast cancer reported in the 2002 Women’s Health Initiative Study was limited to women who took estrogen and progestin together. In other words, progestin was the problem, not estrogen. Women who have not had a hysterectomy are generally given a progestin along with estrogen to prevent uterine cancer, but we now have many safe non-progestin alternatives to protect the uterine lining.
To keep these numbers in perspective, the relative risk of developing breast cancer when taking oral estrogen and progestin hormone therapy is the same as the increased risk of breast cancer associated with obesity and alcohol.
Keep in mind that in the Women’s Health Initiative Study, the overall mortality of women 50-60 years old who were taking estrogen was 27% lower than women who did not take hormone therapy.
There are many menopause experts, including me, who feel very strongly that for women with moderate to severe hot flashes, it's actually far safer to take post menopause estrogen than to NOT take estrogen. That’s because we now know hot flashes correlate very strongly with heart disease, breast cancer, problems with cognitive function and osteoporosis.
Knock out the flashes and you will likely live longer and better than if you decide to tough it out for the next 10 years.
So, if you haven’t already, you should talk to your doctor about your options. If your own doctor is not an expert in menopause or hormone therapy, the North American Menopause Society is your best resource to find a clinician who is.