The use of hormone replacement therapy for women in menopause has been a heated topic of debate for the past 20 years.

Women had been routinely prescribed estrogen and progestin — female hormones that dramatically decrease during menopause — in pill, patch or cream form to help offset its many symptoms.

That all changed about 20 years ago when the Women’s Health Initiative, initiated by the National Institutes of Health to look at the effects of hormone therapy, abruptly canceled the study when it found that some women taking both estrogen and progestin had an increased risk of breast cancer, heart attacks, strokes and blood clots.

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In the aftermath of the study, hormone replacement therapy decreased by about 80 percent in the United States. Despite new studies showing that the benefits for most women under age 60 outweigh any risks, many physicians and patients are still reluctant to prescribe and seek relief from hormone replacements.

Treatment without fear

That needs to change, said Dr. Jeff Chamberlain, an obstetrician and gynecologist at UCHealth Women’s Care Clinics in Steamboat Springs and Craig.

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“I think there’s been a shift during the past 10 years,” he said. “There’s been a re-evaluating of the old studies. Patients are more aware of what’s available and less afraid, and they’re asking the right questions of their doctors to get the help they need and relief for their symptoms.”

Menopause symptoms can be numerous, varied and specific to each woman, and can affect all aspects of her life. While most people can rattle off the usual symptoms of hot flashes, night sweats and mood swings, other issues include depression, sleeplessness, anxiety, forgetfulness, weight gain and a host of other physical ailments such as vaginal dryness and pain during sex.

“It’s very nuanced and very different for every woman,” said Chamberlain.

Hormone replacement therapy can go beyond relieving menopause symptoms. Researchers believe that estrogen can help protect women against osteoporosis, or bone weakening, as they age, and new studies are looking into the important role that estrogen plays in protecting the brain from Alzheimer’s disease.

Chamberlain wants women to become better advocates for their health care during their menopause years, which includes the transition years leading up to it, called perimenopause, where women experience changes in their monthly menstruation cycle.

“As soon as a woman begins to experience some of these symptoms, she becomes a candidate for a host of various and possible treatment options that can bring relief,” he said. “There’s no reason to suffer the way that previous generations of women have.”

Very low risk for women in their 40s and 50s

New research and recommendations consider a women’s age, personal and family medical history, and symptoms when determining the best hormone replacement treatment plan. For instance, a non-smoking woman in her 40s or 50s with no history of heart or stroke issues has a very low risk of adverse effects from hormone replacement therapy.

Women on hormones over the age of 60 have a slightly higher risk for heart and stroke issues, studies show.

“Beyond 60 doesn’t mean that hormones are never appropriate. It’s just that physicians take a longer pause and discuss the potential pros and cons of hormones with their patient,” said Chamberlain. “It’s a ‘to-be-determined’ situation. At that age, injections, patches and oral medications might not be the ‘go-to’ treatment, and instead, topical creams may be more appropriate.”

Open and honest dialogue between women and their physicians is necessary. It can be a positive first step to eliminating the mystery and embarrassment from a stage of life that all women face that can affect many aspects of her physical, personal and professional life.

“These conversations are worth having,” said Chamberlain. “The vast majority of women will notice a difference when they receive hormone replacement therapy. More providers are better educated now about the new guidelines and about the risk-benefit scenarios for their patients. There are risks, but they are very small and balanced against massive benefits.”

“Women living in Steamboat are very informed and active,” continued Chamberlain. “They don’t want to have their lifestyle hindered by menopause, and they want to enjoy the life they have built and curated here.”

Mary Gay Broderick writes for UCHealth. She can be reached at marygaybroderick@comcast.net.