How many flashes should I have? Doesn’t getting old mean sex will be painful? Will I break my hip like Aunt Mary? I don’t want to die from breast cancer like Sue! My cardiologist told me NEVER to take hormones.
I’m a male gynecologist, and I hope you don’t think that means I can’t understand the fears, hopes, and concerns that each of those questions entail. Even though I may never feel a “hot flash”, I think I know how disruptive to life it can be. I also know that women deserve answers to all the questions pose above and more. I have dedicated my life and career to helping women lead productive, meaningful lives by serving their healthcare needs. As I’ve gotten “more mature”, so has my practice, and that meant a LOT more visits where “the change”, and those other fears get discussed.
In the middle of the second decade of the twenty-first century, there’s a great deal of evidence about hormones and women’s health, but there is still some mystery. First, combined hormone replacement therapy absolutely increases your risk of having a blood clot form. Now while this is bad, the increased risk is less than the risk of blood clot from a transcontinental airplane flight, and substantially less than the risk from pregnancy. Second, hormone therapy clearly prevents uterine cancer and bone loss. The risk of breast cancer is increased, but only very slightly. Estrogens keep the vaginal mucosa moist and pliable. It is also fairly evident that the risks from hormone use are different for women just entering menopause and women who HAVEN’T had hormones (either their own or medication) for some time.
If you are losing sleep, companionship, or intimacy, DON’T despair. If you can’t find a doctor who will discuss these things with you, keep looking, as we are out there. If you have been told that only “bioidentical hormones” can be safe or effective, you have been misled. Almost any gynecologist can help you, not just the ones who expect a cash payment and a saliva test monthly.
As physicians who care for women in ALL stages of life, you and your OBG should decide what’s best for you. Hormone therapy isn’t for EVERYONE, but it’s not for NO ONE. Schedule an appointment and see your doctor if you need more information.
Dr. G. Sealy Massingill is the current chair of the John Peter Smith Health Network Department of Obstetrics and Gynecology, the medical director at Midwifery Texas Health Harris Methodist Fort Worth, and an associate professor at the University of North Texas Health Science Center.