Menopause & Hormone Replacement Therapy

Deborah Howell (Host): You know, when women get together, we can talk about anything and everything. So today, let's talk about some of the challenges of menopause. Welcome. I'm Deborah Howell, and today, let's learn more about the diverse treatment options available to women facing menopause, including hormone replacement therapy.

Our guest is Dr. Yu, a Board Certified OB GYN at Memorial Care Saddleback Medical Center and Memorial Care Medical Group, Irvine. Hello, Dr. Yu, so glad you're with us today.

Miao Crystal Yu, MD: Thank you for having me, Deborah.

Host: Our pleasure. So, diving right in, what are the primary symptoms and challenges women experience during menopause, and how can hormone replacement therapy help alleviate them?

Miao Crystal Yu, MD: There are two primary types of symptoms that women experience. One are mostly vaginal symptoms related to vaginal dryness, urinary urgency, frequent urinary tract infections. The others are considered more systemic symptoms such as hot flashes, night sweats, mood changes, and in some cases arthritis.

Host: Yeah, all the fun things, right? So, are there alternative treatments or lifestyle changes that women can consider before opting for hormone replacement therapy?

Miao Crystal Yu, MD: There are a lot of options. Women are always encouraged to talk to their doctors about achieving ideal body weight. They can exercise, they can drink fluids. There's been some studies showing that acupuncture is also helpful, but this is a challenging time for a lot of women and those goals can be hard to reach.

Host: Yeah, I hear you on that one. What are the potential risks and side effects associated with hormone replacement therapy, and how do you determine if it's a suitable option for a patient?

Miao Crystal Yu, MD: Contrary to popular opinion, most types of hormone therapy are safe for young women just as they enter menopause. The safest type of hormone therapy is actually the vaginal preparations. These are targeted for women who have symptoms of dryness, frequent urgency, painful intercourse, and they usually consist of vaginal estrogen, which is applied 2 to 3 times a week. The vaginal estrogen is minimally absorbed by the body, so it is considered a very safe type of preparation. The second option is either oral or transdermal preparations of estrogen, which can be used to treat symptoms of hot flashes and night sweats. Those do have some side effects, but they have been shown to be relatively safe in younger women who are under the age of 60 and who do not have a family history of breast cancer or a significant history of heart disease themselves.

Host: Dr. Yu, how do you personalize hormone replacement treatment plans for women based on their individual needs and their medical history?

Miao Crystal Yu, MD: You know, if women are suffering mostly from vaginal symptoms, they're probably the best candidate for vaginal therapy alone. Now, most women who go through menopause, up to 60 to 80 percent, do experience hot flashes, and those are the ones who will benefit from a short course of hormone therapy. These are usually the oral preparations, sometimes it can also be applied transdermally. For these patients, a short treatment with these medications for up to three to five years until they're at the age of 60, can significantly benefit their well being, can help increase their sleep quality, it can help increase their energy level. And in many cases, there's also been studies showing that can protect their heart and their bone health.

Host: Oh, wow. I hadn't heard that. And what role does age play in the decision to pursue hormone therapy? And are there specific guidelines for women at different stages of menopause?

Miao Crystal Yu, MD: Correct. Most of the studies on menopause, have shown that it is relatively safe for younger women who just enter menopause. That means that for women under 60, the risks of hormones often are less than the benefits. So hormone therapy is safer for those younger women.

Now, things that we consider is the risk of heart disease, the risk of blood clots, which is very low for young women when they first start hormone therapy. For women over 60 who take hormone replacement, there can be a higher risk of heart disease and stroke, but that must be discussed and individualized with their primary care doctor.

Host: Now, are there any natural or holistic approaches that can complement hormone replacement therapy to manage menopause symptoms effectively?

Miao Crystal Yu, MD: Some women do use over the counter supplements, which can be safe. Some of these include supplements like Primrose Evening Oil, Black Cohosh, Estroven, Estrovera. All of these supplements are designed to increase the natural circulation of estrogen in your body. So, those can be discussed with your gynecologist prior to starting hormones as well.

Host: Good idea. A very good idea for all women. Now, can hormone therapy impact a woman's long term health, including the risk of conditions like heart disease and osteoporosis?

Miao Crystal Yu, MD: The studies that we have seen show that when young women start hormone therapy, this is women under the age of 60; there's significant benefit to their heart and to their bone health. For women who are older than 60, the risks of hormone replacement may outweigh the benefits. These women are at higher risk for heart disease given their age and their other comorbidities, so taking hormone replacement beyond the age of 60 can have higher risks.

Host: What steps should women take to stay informed and make well informed decisions about their menopause and their hormone replacement therapy options?

Miao Crystal Yu, MD: I think the most important is just to have a conversation with your gynecologist. Most women are often very shy to talk about hormones, to talk about menopause; but many gynecologists now welcome these conversations and there are many treatment options available to women. So the first thing is to have a conversation and let your doctor know about your symptoms.

Host: Okay. Good advice. Are there any recent advancements or emerging treatments in the field of menopause management and hormone therapy that women should be aware of?

Miao Crystal Yu, MD: I think there are many options for treatment of hot flashes, which don't involve hormone replacement. There's a newer class of medications, which is newly FDA approved called Veozah, and this is actually a neurokinin receptor antagonist, which helps to treat symptoms of hot flashes without estrogen. So these are beneficial for women who have a history of breast cancer or who cannot take hormones for another reason. So this is an emerging field. New medications will definitely come out and give women additional options.

Host: I love that, because we love our options as women, for sure. Tell us about the new stuff.

Miao Crystal Yu, MD: Very important.

Host: Is there anything else you'd like to add to our conversation, Dr. Yu?

Miao Crystal Yu, MD: I think menopause is getting more attention in the media nowadays, and I think there's more conversations in general about it. So, I encourage all women to have a conversation with their friends or their physician, and learn as much as they can during this process.

Host: Absolutely. And if you'd like to learn more about hormone replacement therapy at Saddleback, please go to www.memorialcare.org/womenshealth. Thank you so much, Dr. Yu, for your time and your expertise today. We really enjoyed having you on the podcast.

Miao Crystal Yu, MD: Thank you, Deborah. Have a good day.

Host: That's all for this time. I'm Deborah Howell. Have yourself a terrific day.