Menopause is defined as the cessation of menses for 12 consecutive months. While many women celebrate the end of those pesky periods, the hormones fluctuations during the transition can cause a multitude of symptoms including weight gain, sleep disturbances, libido changes, brain fog, mood disturbances, fatigue, hot flashes and night sweats. Not all women experience every symptom and they can range in severity from merely annoying but tolerable to severely disrupting quality of life.
I have developed several basic philosophies when it comes to hormone replacement therapy (HRT) during the last 10 years:
· Treat the individual symptoms of each woman
· Use the lowest dose to alleviate those symptoms
· Avoid oral estrogen when possible
· Avoid synthetic hormones
· Use the HRT for the shortest length of time needed to control the symptoms
That last statement had many women asking for clarification. I have already reconsidered my token response of 2-5 years since it depends on the woman and the specific symptom. I have many women using infrequent low dose vaginal HRT for vaginal dryness and bladder symptoms indefinitely. The more transitional symptoms, such as hot flashes, usually require higher doses to control making limited time of therapy a reasonable precaution.
A recent article published in February this year has caused me to further re-evaluate the length of therapy. The article used data from the Study of Women’s Health Across the Nation (SWAN) to observe 1449 women with frequent hot flashes. The reported time ranged from 6 months to 14 years with an average duration of 7.4 years! Women who were postmenopausal (over 12 months since last menses) when the hot flashes started, had the shortest duration at 3.4 years. For the majority of women, hot flashes start while still having regular or even irregular periods. We get to look forward to an average duration of 11.8 years of these wonderful power surges. Compared to women in other ethnic groups, African American women reported the longest duration.
I think 5-10 years may be a more appropriate response when asked about possible duration of therapy for transitional menopausal symptoms. If it helps, don’t think of it as a hot flash, think of it as a very brief, very private vacation in the tropics!
Nancy E. Avis et al. Duration of Menopausal Vasomotor Symptoms Over the Menopausal Transition. JAMA Intern Med. February 2015.