Hormone Replacement Therapy - Risks, Research and Relief

Original article found here

Ever since the large government study called the Women’s Health Initiative found a number of risks associated with menopause hormones, millions of women who are in or near menopause have been weathering hot flashes and other symptoms on their own. But now, new research suggests that the benefits of short-term hormone treatment to control life-disrupting menopausal symptoms outweigh the risks — as long as the treatment is started at or near menopause.

There are also lots of products now available and different ways to use them that enhance the safety of hormone replacement. And there is even an app to help women and their doctors explore various options and choose the most suitable treatment.

To help women and their doctors assess H.R.T. options and select the best treatment for women 45 and older with menopausal symptoms, the North American Menopause Society has developed a mobile app, MenoPro, for iPhone/iPad and Android devices.


Women have long been worried of the risks of of cancer, blood clots or heart disease. Most professional medical societies concerned with women’s health now recommend treatment for menopausal symptoms for up to five years using therapy that combines estrogen and progesterone and even longer for those who take estrogen alone.

Every day, about 6,000 women in the United States — more than two million women a year — enter menopause. At an average age of 51, they stop having their periods because their ovaries no longer produce enough estrogen to stimulate growth of the uterine lining that is shed each menstrual cycle.

For months before and up to a decade or more after menopause begins, many women have symptoms that can seriously diminish the quality of their lives by disrupting their productivity, sleep, moods and ability to enjoy sexual intercourse.

The most common symptom — hot flashes — can leave some women dripping with sweat for minutes at a time several times a day and especially during the night. Menopause-related vaginal dryness and atrophy can result in severe sexual discomfort, pain and bleeding with exercise, vaginal and urinary infections and incontinence.

Until the early 2000s, many women with menopausal symptoms took hormone replacement therapy — H.R.T. — to counter them. Even some who did not have disturbing symptoms used H.R.T. because observational studies indicated it lowered the risk of cardiovascular diseases, and popular books and articles suggested it delayed signs of aging.

Then in 2002, the results of the largest randomized clinical trial of hormone replacement, the Women’s Health Initiative (W.H.I.), created a kind of menopausal panic, prompting millions of middle-age women to stop or not start hormone treatments and doctors to not prescribe them.

The study found that, among the women treated with the hormones, there was an increased risk of heart attacks, strokes, blood clots and, most frightening of all to many women, a slightly higher risk of breast cancer among those randomized to take the leading H.R.T. regimen of conjugated equine estrogens (Premarin) and a synthetic progesterone (Provera) recommended for women who still had a uterus. (Those without a uterus, who were randomized to take conjugated estrogens alone, had no increase in breast cancer; in fact, they had a slight decrease over all.)

However, according to Dr. JoAnn E. Manson, an endocrinologist and one of the principal investigators for the W.H.I., “The W.H.I. findings have been seriously misunderstood and misinterpreted,” and millions of women for whom the benefits clearly outweigh the risks are needlessly being denied treatment. “The pendulum has swung too far,” she said.

In the years after the W.H.I. findings, many new analyses and studies have prompted experts to rethink the wisdom of avoiding hormone replacement, especially for women within a few years of menopause whose personal and family history do not place them at high risk of breast cancer.

In an analysis in 2013 in the American Journal of Public Health, Dr. Philip M. Sarrel and his co-authors calculated that, based on reduced death rates among women taking only estrogen in the W.H.I. study, avoiding hormone replacement resulted in the premature deaths of 18,601 to 91,610 women in the decade after the study’s release.

Dr. Manson is distressed about the large number of women — about a third of those now on hormone replacement — who are relying on “custom-compounded” products that have not been reviewed for safety and effectiveness by the Food and Drug Administration. They come with no warnings in a package insert and could contain contaminants and inconsistent dosages, she said.


“There’s little or no reason to go the custom-compound route,” she said. “Women today have so many options — a wide array of doses, from low to traditional, and ways to use them.” In addition to pills, there are patches, gels and sprays applied to the skin. Vaginal and urinary symptoms can be treated with vaginal inserts containing very small amounts of estrogen that do not enter the bloodstream and thus are safe for women who have had breast cancer.


Women Run This Sport

As many of you know, June 1st was National Running Day! Ladies, we know you like to get right back to running after having a baby. Running is an excellent way to get back in shape and can be a healthy way to de-stress. Before doing this or any other high impact exercise, it is so very important to make sure you strengthen and properly engage your pelvic floor muscles, deep intrinsic and abdominal muscles before getting back to your routine workout, to prevent issues like incontinence.

Below is an interesting article that was posted in The Wall Street Journal, highlighting the fact that women are truly taking over the sport of running! 

Tell us what motivates you - I run because . . .

How Women Took Over the World of Running

Across most long and short race distances, women now outnumber men; a rise fueled by social and charity groups





Women and girls, not long ago an afterthought in distance running, now own it.

They made up 57% of the 17 million U.S. race finishers in 2015, according to industry-backed tracker Running USA. That includes everything from 3.1-mile trots before Thanksgiving dinner to 26.2-mile marathons.

Mary Wittenberg, former director of the New York City Marathon, says races for women have become less common as they have become 57% of all U.S. race finishers. 

Many women run to win prize money or medals. Millions more have taken to treadmills, sidewalks and running trails to achieve personal bests, socialize and improve overall health.

Mary Wittenberg, CEO of Virgin Sport, is a longtime runner and the former CEO of New York Road Runners, which operates the New York City Marathon. She notes that there are fewer women-only events than there used to be because at most races, women are the majority.

“It’s amazing growth,” she says. Running appeals to women because “if you put the work in, you can do it. Completing the distance has become as big a goal as your time. That makes it far more accessible.”

Women were still a small minority of overall race finishers in 1984, when American Joan Benoit Samuelson won the first women’s Olympic marathon, 88 years after the first men’s Olympic marathon. A trickle of female amateurs followed her into running.

A decade later, Oprah Winfrey finished the 1994 Marine Corps Marathon in the Washington, D.C., area in just under 4½ hours, wearing bib No. 40 to reflect her age. Thousands of people cheered her on along the course and at least three reporters ran the race with her to cover her feat. One of them was Amby Burfoot of Runner’s World magazine.

About a year after that, Mr. Burfoot, who also won the 1968 Boston Marathon, took a surprising phone call. He says it was someone from Race for the Cure, a relatively new series of road races for women to raise money for breast-cancer research. Organizers said they had more than 10,000 women registered for a race in the Midwest.

“It was the funniest thing we’d heard in the world,” recalls Mr. Burfoot, now an editor emeritus who recently wrote a book about female pioneers called “First Ladies of Running.”


“We were Runner’s World, and we were completely unaware that there was this tidal wave,” he says.

In the past decade, races with entertainment along the course such as the Rock ‘n’ Roll Marathon Series have become the highlight of ‘girls’ ’ weekends as more women joined the ranks of runners. 

Men made up 68% of U.S. road-race finishers at the time. After Ms. Winfrey’s finish and with a rapidly expanding number of women’s races, their participation surged. Women surpassed male finishers by 2010.

Women have flocked to running more than other endurance sports. Less than 15% of USA Cycling’s 62,000 members are women, a spokesman says. The group oversees all major disciplines of competitive cycling. About 47% of the 63,000 members of U.S. Masters Swimming, a nationwide training group for swimmers age 18 and above, are women, according to the organization.

Tracey Russell was a competitive swimmer in college but says running has an advantage in helping women form bonds. Although it’s common for people to chat while they run, “it’s hard to do that during [swimming] intervals,” she says.

Ms. Russell is CEO of Conqur Endurance Group, which owns the Los Angeles Marathon. She says the surge in charitable organizations forming training groups and raising money through road races has largely been driven by women.

In this year’s L.A. Marathon, women made up 46% of runners but 59% of entrants through charities, which give runners a discount or free race entry in exchange for fundraising certain amounts.

Nationwide, women made up 44% of marathoners and 61% of half-marathoners in 2015, according to Running USA.

One surprising influence in the rise of women’s running: improved gear. For decades, athletic-apparel manufacturers paid little attention to women’s needs. Many women ran in one-style-fits-all running shorts and ill-fitting sports bras.

Recent years have brought an avalanche of apparel for women, from boutique designers to major manufacturers such as Under Armour and Adidas.

Much of it is worn lounging on the couch. But it was women’s rising interest in health and fitness that stirred companies to focus on them.Nike forecasts that sales of its women’s products will roughly double by 2020.

Years ago, “you always didn’t feel good going out for a run,” says Toni Carey, who lives in Atlanta. “Now I can go to whatever brand that’s going to make me feel good, look good and support the activity I’m doing.”

Ms. Carey and a college friend, Ashley Hicks-Rocha, five years ago turned their running blog into Black Girls Run!, a nationwide organization to promote running among African-American women. (“ ‘Girls’ is used as a term of endearment,” she says.)


Female runners are helping racially diversify distance running by forming groups such as Black Girls Run!, an organization for African-American women. PHOTO: RIDLEY INGRAM/SPORTING EVENTS FOTOS

Black Girls Run! has about 70 groups nationwide and 200,000 participants. Some run “virtual” races, where runners register for a 5K or 10K distance, complete it on the honor system and receive a medal in the mail. The option appeals to new runners intimidated by formal races, Ms. Carey says.

Women’s groups like Ms. Carey’s are helping further diversify running, Ms. Wittenberg says. Participation of racial minorities has climbed in recent years, according to Running USA.

“It would just be great to see the men’s side see growth, too,” she says.

Instead of running, some younger men especially have joined the trend toward weightlifting and high-intensity interval training. Overall participation in road raceshas dropped in the past two years as millennials have shown less interest in running than older adults. Average finishing times for men and women also have slowed down as race fields have gotten older and grown to include more recreational runners.

For many women, running is less a competition than a social experience.

Five years ago Pam Burrus, a 35-year-old mother of two who lives outside Atlanta, founded Moms Run This Town, a training and social group that now has about 700 chapters, most of them in the U.S.

Members can join group runs or organize their own runs via the group’s Facebook pages. The group also goes by the name She Runs This Town, after attracting daughters and nonmothers. “It’s become our ‘us’ time,” she says.

Running might especially benefit the mental health of women, who suffer from more depression than men do. Studies have shown that both aerobic exercise and sunlight can improve mood in people with mild to moderate depression.

Ashley Lauretta, a 29-year-old freelance journalist in Austin, Texas, says she started running after a college counselor suggested it could help her anxiety disorder by helping her control her breathing. It did.

“I like how uncomplicated it is compared to other sports,” she wrote in an email. “You just need the right pair of shoes and you can get out and go.”

Write to Rachel Bachman at rachel.bachman@wsj.com