Hormone Therapy — What We Know & What We Don’t

Q: How do you know if you’re a good candidate for hormone therapy?

Dr. Gillian Goddard:
The number one indication for starting hormone therapy is if you are having symptoms.

And the symptoms that hormone therapy has been shown to treat very effectively are the classic perimenopausal symptoms: hot flushes, night sweats, sleep disruption.

Now, there’s a million other symptoms that we now realize may be related to perimenopause.

It’s not that estrogen and progesterone might not help those symptoms. It’s that we don’t have a lot of data that supports the idea of using hormone therapy for some of these other symptoms that people experience.

Q: What other symptoms can hormone therapy help with?

Dr. Gillian Goddard:
Certainly vaginal estrogen has been shown to be helpful with vaginal dryness. And my least favorite diagnosis, vaginal atrophy. That needs a rebrand.

Testosterone has really been tested mostly for sexual function in women.

And so there’s lots of different ways to come about treating all these symptoms.

Q: Does estrogen protect against cardiovascular disease or dementia later in life?

Dr. Gillian Goddard:
Where the data is confusing, and where people I think feel like they’re being left out of the conversation if they can’t take estrogen, is the idea that estrogen may be beneficial for long-term health.

Right now, the data, despite what a lot of people are saying, is not really there.

The idea that estrogen reduces your risk for cardiovascular disease or dementia many, many years in the future is not completely clear.

And the reason for that is because the studies that would prove that are really complicated to do. They would need to be many decades long.

So what we have instead are observational studies. And those studies show that there’s an association between estrogen and these outcomes.

But the women who are opting into taking estrogen may be different from the women who aren’t opting into taking estrogen in really, really important ways.

For example, they may have better access to healthcare. They’re often better educated. They have higher incomes.

All those things are also associated with having less cardiovascular disease, less dementia. So it’s really difficult to piece that type of data apart.

---