Favorable Winds for the Hormonal Treatment of the Menopause

A new guide published by the British National Health Service has recognized the virtues of Hormone Replacement Therapy.

The publication has received widespread media coverage in the United Kingdom, as shown by the two articles published in The Guardian in November last year. This repositioning of official medicine is gradually approaching the position and approach proposed by Age Management Medicine (or Preventive Anti-ageing Medicine).

Neolife medical management

The national public healthcare system reviews your views on the menopause and hormone replacement therapy.

In November 2015 news broke that had socio-health implications for the controversial hormone replacement therapy (HRT) and the menopause. This is the first guide on the subject published by the British National Health Service (National Institute for Health and Care Excellence-Nice). The objective of this document is to provide physicians with updated information based on the latest scientific literature and also to inform patients to take part in the decision about how they should be treated.

Hormonal Treatment for the Menopause

The publication of this guide had a widespread impact in the United Kingdom, as can be seen in some articles published in The Guardian:

In Spain the average age of the menopause is around 51 years old and it is estimated that there are between 1 and 3 million women with symptoms which include night sweats, hot flushes, lack of drive (lethargy), fluctuations in mood, decreased libido, etc. For some women these symptoms can seriously affect their quality of life and usually last for about 4-5 years. As a result hormone replacement therapy is the appropriate treatment to combat the above symptoms.

Hormone replacement therapy for the treatment of menopause began in the 1960s and quickly became popular in developed countries. For socio-political reasons in Spain, this happened much later. At the beginning of the 21st century some results were published from a couple of large clinical studies that demonstrated links between hormone replacement therapy and cardiovascular disease, brain thrombosis and breast cancer. These studies were the WHI (Womens Health Initiative), which was published in the USA in 2002, and the Million Women Study, which was conducted in the United Kingdom and published in 2003. A scandal was generated and the press coverage caused panic and concern about these results and millions of women stopped receiving treatment for symptoms acting under their own initiative and/or on the recommendation of their doctors.

It has been 15 years and things have finally returned to their original course. Properly prescribed and monitored hormone replacement therapy is beneficial for women’s health and their quality of life. We have already discussed this in the Neolife blog on several occasions:

After multiple commentators criticized the studies and voiced concerns regarding HRT in 2002 and 2003, “mainstream medicine” must now re-position itself in favor of HRT.

Many commentators have criticized the studies:

  • For example, in the WHI study pregnant mare estrogen (conjugated equine estrogen) and medroxyprogesterone acetate were used instead of the woman’s natural hormones (17 beta estradiol and progesterone)
  • In addition, the average age of the women in the study was 62 years old (13 years after the menopause on average), many of them overweight, obese (34%), hypertensive (36%) and smokers. When the study was reinterpreted by analyzing the results from the youngest women in the study (those under 60 years of age), it was found that there was insufficient evidence to support an increase in cardiovascular risk.
  • The increased risk relating to breast cancer was directly linked to the use of a synthetic progestogen, medroxyprogesterone rather than the natural female hormone progesterone.
  • The increased risk relating to thromboembolisms was associated only with orally taken estrogen (not transdermally, mucosally or subcutaneously) in women over 60 years of age who also presented with other cardiovascular risk factors, such as smoking and obesity.
  • Interestingly, the same study showed a significant reduction in hip and spine fractures in those who suffer from osteoporosis and a lower incidence of colon and rectal cancer, but these beneficial effects were not disclosed…

The new NICE guidelines (National Institute for Health and Care Excellence), the equivalent of the Spanish INS, reflects the “official” positioning of British public healthcare system, which is approaching the position of Age Management Medicine, and distances itself from the position which had previously opposed HRT. Little by little “mainstream medicine” (the official medicine) will have no choice but to acknowledge the scientifically proven benefits of HRT, as well as recognize that the side effects attributed in the original studies were related to a inappropriate prescription of molecules similar to the natural hormones, but not identical. Furthermore, HRT is not limited to the treatment of menopause: it is a complete preventive therapy for both women and men. And it is not just limited to estrogen and progesterone: there is also testosterone, DHEA or melatonin, among other beneficial hormones which can be used.

The British public healthcare system is very similar to the Spanish system and both are of a high quality which rely on protocols and interventionist-style medicine. But the British population, because of their close-relationship to the Americans, is more informed about the demands of American society and therefore they will be the first Europeans to massively demand HRT be made available to all, as is already occurring in the US. Spaniards, particularly Spanish menopausal women, will still have to suffer the deterioration in their quality of life and health for a few more years until our health authorities show a willingness to advance with science in this regard. And all this despite the fact that SEGO (the Spanish Society of Gynecology and Obstetrics) openly criticized the aforementioned studies which took place in 2002 and 2003 back in 2008.

At Neolife we ​​recommend hormone replacement therapy, as long as it is properly prescribed and monitored.

At Neolife we inform our patients of the benefits and possible risks associated with Hormone Replacement Therapy taking into account their personal characteristics (age, cardiovascular risk, poor habits…) and we value the different forms of administration (gels, pellets, tablets etc.) to successfully personalize the treatment to each patient. We always use bioidentical hormones. In addition, we require a complete gynecological study (mammography, cytology and ultrasound) with in the last 9 months and we regularly monitor the development of symptoms, as well as the plasma levels of different hormones in the body.