Women’s health: Women in their 50s face changes, choices like hormone therapy

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For women in their 50s, lower estrogen levels lead to menopause and a whole set of health concerns.

"This is the beginning of the aging process," says Kate Beadle, a Kaiser Permanente nurse practitioner who specializes in menopause.

Dr. Audrey Curtis, who's helping start a women's health clinic at Legacy Meridian Park, says: "A lot of women feel like they're on a roller coaster. Their hormone levels are doing what they did in the teenage years, really up and down."

For some women, the answer is hormone replacement therapy to deal with symptoms of menopause. But the 50-year history of HRT has been as wild as the mood swings it is supposed to prevent. And the changing recommendations for women, as well as cancer fears, have led to confusion and stress.

Introduced in the 1960s, long-term estrogen treatment was marketed as a wonder therapy to combat aging, disease and depression. Two 1975 studies indicating increased cancer risk made a temporary dent in sales, but it didn't last as other hormones like progestin were added to the therapy, supposedly eliminating the added cancer risk.

In 2002, a major study by the federal Women's Health Initiative made a much bigger impression, linking estrogen-based treatment and elevated cancer risk. And estrogen was not a miracle drug that prevented certain chronic diseases, contrary to an earlier study.

Since then, the Women's Health Initiative has been criticized for design flaws by medical researchers and other experts, and even its authors have backtracked on some of their warnings of elevated risk of heart disease.

In 2012, the U.S. Preventive Services Task Force issued a review of published research, including the Women's Health Initiative, and did not address the use of HRT to treat symptoms of menopause. However, it recommended against the use of HRT by post-menopausal women to prevent chronic disease.

The task force concluded:

Estrogen plus progestin and estrogen alone decreased risk for bone fractures.

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Women's health: Women in their 50s face changes, choices like hormone therapy

Hormone replacement therapy: British Menopause Society and Women’s Health Concern release updated guidelines

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May 24, 2013 The British Menopause Society and Women's Health Concern have today released updated guidelines on Hormone Replacement Therapy (HRT) to provide clarity around the role of HRT, the benefits and the risks. The new guidelines appear in the society's flagship title, Menopause International, published by SAGE.

Over the last 11 years, HRT has changed from being branded the "elixir of youth" to being considered extremely risky and only to be used in certain circumstances. Since the publication of the Women's Health Initiative (WHI) trial in 2002, and the Million Women study (MWS) in 2003, confusion and controversy has surrounded the use of HRT and the known benefits have often been forgotten.

A panel of experts have carefully considered, researched and reanalyzed the WHI and MWS studies alongside conducting further trials and studies, to offer practioners a detailed review of the evidence to help them optimize their clinical decisions, and provide women with more balanced and accurate advice on HRT treatment for menopause.

The new HRT recommendations are designed to complement the BMS Observations and Recommendations on menopause. The updated guidelines detail key recommendations targeting access to advice on how women can optimize their menopause transition and beyond, focusing in particular on lifestyle and diet and an opportunity to discuss the pros and cons of complementary therapies and HRT.

"Our aim is to provide helpful and pragmatic guidelines for health professionals involved in prescribing HRT and for women considering or currently using HRT" says Nick Panay, Chair of The British Menopause Society and lead author of the recommendations. "With these updated recommendations, it is hoped that HRT will once again be used appropriately and provide benefits for many women in their menopause."

"The 2013 British Menopause Society & Women's Health Concern recommendations on hormone replacement therapy" by Nick Panay, Haitham Hamoda, Roopen Arya and Michael Sarvas on behalf of the British Menopause Society and Women's Health Concern, published by SAGE in Menopause International, XX June 2013.

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The above story is reprinted from materials provided by SAGE Publications, via EurekAlert!, a service of AAAS.

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Hormone replacement therapy: British Menopause Society and Women's Health Concern release updated guidelines

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Where Do the Hormones in Hormone Replacement Therapy Come From by Dr. Howard Liebowitz - Video

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