Early menopause linked to higher death rates in women. What to know about hormone replacement therapy, according to experts

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A new study has revealed the "serious" health risks of premature menopause. According to research conducted by the University of Oulu and Oulu University Hospital in Finland, women who enter menopause before the age of 40 are at a significantly higher risk of early death, particularly from heart disease and cancer.

The study, which is the largest of its kind to date, compared the health records of 5,800 women diagnosed with premature ovarian insufficiency (POI) to 23,000 women who entered menopause at a standard age. Researchers found that women with POI are twice as likely to die from heart disease and four times as likely to die from any type of cancer.

These findings are consistent regardless of whether the menopause was natural or medically induced. Dr. Vanessa Soviero, an OBGYN from the Katz Institute of Women's Health at New York's Northwell Health, told Medical News Today this research "confirms the serious implications of premature menopause on women's health, which requires urgent attention from both health-care providers and patients."

Now, experts are advocating for hormone replacement therapy (HRT) as a crucial element in treating early menopause. Women who used HRT for at least six months, according to the study, were 50 per cent less likely to die from cancer and other causes.

The study also highlighted the need for women, especially those who enter menopause before age 40, to consider hormone treatments early, even before symptoms of perimenopause appear. "The earlier you start hormone therapy, the more you benefit from its protective effects against cardiac, cognitive and bone health issues," Soviero explained in Medical News Today.

While there are benefits to HRT in reducing risks associated with premature menopause, it is not without risks. But it may be an important consideration for Canadians who are struggling with their symptoms. Here's what you need to know.

What is menopausal hormone therapy?

Hormone replacement therapy (HRT), or more commonly referred to as menopausal hormone therapy (MHT) in Canada, is a medical treatment used to alleviate symptoms associated with hormonal changes during perimenopause (the stage before menopause where someone is still menstruating) and menopause.

According to a 2023 study published in the Canadian Medical Association Journal, hormone therapy should be the first treatment offered to women under the age of 60 who are suffering from hot flashes, night sweats and other symptoms of menopause.

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In Canada, commonly prescribed forms of MHT include estrogen-only or combined estrogen and progestogen therapies. Dr. Susan Goldstein, a Menopause Society certified practitioner and an assistant professor at the University of Toronto, previously told Yahoo Canada estrogen is the main hormone that helps with menopausal symptoms such as hot flashes, mood swings and vaginal dryness.

"Progestogen has other benefits, but the main one is to protect the lining of the uterus," she added.

Estrogen and progestogen can be administered through various methods such as oral pills, patches or gels, tailored to meet individual needs. "The regimen that we use for menopausal hormone therapy differs depending on whether or not we're starting to treat women before they've had their final menstrual period or after," Goldstein said.

If women are still having their period, they will usually be prescribed a combination of estrogen and progestogen in a cyclic manner, which is a pattern similar to a birth control pill. In contrast, Goldstein said once women have stopped having their periods, they're given continuous regimens of hormones so they're taking estrogen and progesterone every day.

When treating postmenopausal women, other hormone regimens include TSEC (or a tissue-selective estrogen complex), which is a product that includes a combination of estrogen and a selective estrogen receptor modulator. And lastly, a product called STEAR (selective tissue estrogenic activity regulator), which is a sex steroid and hormonal product that has estrogenic, progestogenic and androgenic properties. Goldstein said both the TSEC and STEAR products are used once a day and do not contain progestogens.

As a resource for practitioners and people who want to know more about menopause and different hormone therapies, Goldstein recommended using the Menopause Quick 6 (MQ6) assessment tool, which discusses symptoms and provides tables showing different available products.

What are the benefits of menopausal hormone therapy?

MHT can offer several benefits for women experiencing menopausal symptoms, including:

• Relief from hot flashes and night sweats

• Mood stability

• Prevention of bone loss and lowers risk of osteoporosis

• Improved vaginal health including dryness and reduced risk of urinary tract infections

• Better sleep

Are there any risks?

Hormone replacement therapy was previously considered too risky due to an influential 2003 clinical trial done by the Women's Health Initiative (WHI). The clinical trial linked hormone therapy with a higher risk of breast cancer, blood clots, stroke and heart disease. Many doctors have since said the trial exaggerated the dangers of the treatment, particularly for younger women, and follow-up studies have debunked the WHI data.

"Menopausal hormone therapy is quite safe in appropriately-chosen women," said Goldstein. She added women still need to be screened appropriately because hormones can make women more prone to having blood clots, just as the birth control pill can.

For women under 60 who are within 10 years of their final period, Goldstein said MHT is quite safe and can potentially even benefit healthy younger women. She noted non-hormonal options might be offered to women farther up in menopause, or for those who are older when they're seeking treatment. It might also be an option for those who have medical conditions that put them at higher cardiovascular risk.

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