Menopause & the Women’s Health Initiative

Many women face menopause with uncertainty, due to the misconceptions and misunderstandings that have been associated with menopause for years. This blog aims to shed light on this important transition in a woman's life and explore resources available to women as they navigate perimenopause and menopause. 

Menopause is traditionally described as beginning 12 months after the end of your last period. Perimenopause is the time leading up to menopause and may last many years and come with a variety of symptoms.

In general, the average age of menopause is 51, but menopause can occur anytime between ages 45 and 55. Women may prematurely enter menopause much earlier for a variety of reasons.

There is no question that the hormonal effects of perimenopause and menopause can and do affect women’s physical, emotional, mental, and social well-being. A 2002 study known as the Women’s Health Initiative (WHI), retrospectively viewed as a flawed study, announced that the medical risks associated with hormone replacement therapy (HRT) outweighed the benefits. 

One misconception perpetuated by the WHI comes from the ages of participants. The average age of participants in the study was 63. This is much older than the average age of menopause, which is around the age of 51. We now know that the “timing hypothesis” shows that younger women closer to the onset of menopause are more likely to benefit from hormone replacement therapy, but the WHI study did not study women close to the onset of menopause. 

Therefore, their results are not an accurate representation of what one can expect when HRT is initiated near the time of menopause. The window of opportunity to receive the best benefits from taking estrogen is thought to be within 10 years of the onset of menopause.

In addition, when reporting on risk of developing breast cancer when using hormone replacement therapy, the study primarily focused on relative risk rather than absolute risk. When absolute risk is evaluated, the numbers are far different: a 25% increased risk of developing cancer changes to .08% increased risk. 

Lastly, the WHI study only used one formulation of menopausal hormone therapy. Both the estrogen and progesterone that were used are types of hormone therapy, but they differ from modern bioidentical options that are more typically offered today.

Unfortunately, because of the study, much education on this transition in a woman’s life was not given the attention it deserved. However, not many years ago, many medical providers—including some of the authors of the WHI study—clarified some of the WHI findings, taking a closer look at what the study actually revealed about women’s health. We are now in a new era with better information of what constitutes absolute risk where menopausal hormone therapy is involved.

If you look up menopause on the Internet, most sites will give you a short version of the symptoms of menopause. These lists typically include hot flashes, night sweats, vaginal dryness, difficulty sleeping, insomnia, depression, and anxiety.

In truth, the symptoms of menopause are wide and varied and go way beyond those mentioned above. Those symptoms just happen to be the most obvious.

Regardless of whether women have significant symptoms or not, it is important to understand that menopause puts women at increased risk for a long list of conditions and diseases. As your estrogen levels go down your risk goes up. In fact, many describe the transition into menopause as an “inflammatory event.”

As women enter menopause, they are at increased risk for osteoporosis, coronary artery disease, insulin resistance, neuro inflammation (which may lead to Alzheimer’s), sarcopenia (a loss of muscle mass), and visceral fat gain.

All of this information may seem daunting and is certainly not encouraging for women as we age. However, the good thing is that there is information out there, and knowledge is power! It is more important than ever that women advocate for themselves as they enter perimenopause and the menopause transition. Connect with a healthcare provider that will listen to your symptoms and work with you to find the best therapy. 

Although hormone therapy may not be for everyone, there is much evidence to suggest that it has significant benefits for the majority of women. While menopause is a naturally occurring event in a woman’s life, it does not come without significant risk. Patients and their healthcare providers should work together to find the best way forward for each individual case.

For Dr. Blossom, breaking out of the typical model of medicine has allowed her to give each patient the care they deserve in an environment that is comfortable for both the physician and the patient. If you’re ready to get started with your concierge medicine journey, visit https://carlyleconciergemedicine.com/contact.