here's a question from Lisa luck she asks and this is a question I'd like to know too how long can a woman safely be on HRT with put without putting herself at a higher cancer risk my doctor suggested I go off them after five years and I miss them so much I hear you Lisa there are so many mixed messages about this thank you so there are mixed messages and again the follow-up data to the Whi showed that whether or not someone was on estrogen or progesterone or estrogen alone there was there were you looked
18 years out in the safety data was actually very good there was no increased morbidity or mortality in either group my feeling is if somebody is well I will not take them off of hormones after five years there are proven benefits now we're not supposed to say it one uses hormones for primary disease prevention and the United States prevention preventive service task force just came out with a state statement stating that hormones are not for primary disease prevention but we do know that hormones really do help keep a woman's cardiovascular risk low particularly when the
estrogens use transdermally and in addition it helps bone we know that that's very important and lowers one's risk of developing type 2 diabetes so I really feel strongly that the use of menopause hormone therapies absolutely has to be individualized and we it's something I discuss with my patients annually and if someone should develop a contraindication or a reason why they can't be on hormones I will take them off of them I try to really shift my patients particularly as they're getting into their 60s if they've been on an oral formulation to consider transdermal estradiol because
it really has a safer profile we don't have to worry about changes in lipid profiles we don't have to worry about clotting so it's very that data is really really reassuring but when I have patients on hormones I do not have an end point in mind and that rule about five years is passe if you will so perhaps Lisa should talk to her doctor or change doctors if she wants to stay on hormones and I was going to say there are a lot of other advantages to hormone therapy and maybe they're more superficial but estrogen
helps your skin it helps you be more clear thinking it helps with brain fog it helps with hair I mean estrogen is kind of a Wonder hormone if you ask me I I agree and it's very interesting certainly when I trained and earlier on in my career we weren't really supposed to talk about those things or have that factor into the discussion we would have with our patients in terms of why someone should go on hormones but quite honestly the discussion of hormones has to do with the quality of life and it has to do
with sexual function cognitive function sleep and it's an overall sense of well-being you know we know that obviously we want to take care of our bones and our muscles and our joints and it's very interesting because many women start to have joint aches and pains with menopause you hear of so many women having Frozen shoulders it's not it's not a coincidence so I think yes there's so many benefits that go beyond vasomotor symptoms yet the FDA approves hormones for vasomotor symptoms also from maintaining bones and preventing osteoporosis not for treating osteoporosis but from preventing further
bone loss so the way I would look at it is and the same thing when I would speak to my obstetric patients hormones affect every single organ system of the body and it's really true we could walk through every organ system of the body and talk about the benefits of being on hormones but then again not everyone wants to and not everyone can be so it clearly has to be individualized and it's not one size fits all medicine we have a whole array of options and what works for one patient may not work for another
and what works for a woman who is newly menopausal may not work for somebody who is in her 60s Chris asks wondering if Dr B has any advice on the pros cons or risk benefits to a woman beginning HRT after being in menopause for 10 plus years I can't seem to get an answer on this I know there are many benefits for HRT for brain heart and bone health if there's no family history no family cancer history does it make sense to begin HRT that's a really really really great great question the current prevailing philosophy
regarding starting and initiating hormone therapy is we want to start it within 10 years of final period and before the age of 60. and it's really unfortunate because in my practice I have 60 year olds coming in and say oh my gosh I missed the boat I can't believe it and I've in my practice I've made a few exceptions to the rule if I have somebody who's just 60 or just 61 and they recently went through menopause and they are healthy as can be their cholesterol is fine their blood pressure is fine we'll look at
their bones and we will have a discussion again weighing the risks and the benefits but as a rule of thumb if somebody is 10 years out I won't now what is interesting is unfortunately many young women who went through very early menopause well before the age of 40 who were not offered hormones the question frequently comes up in my meetings you know can you then give a woman hormones and it certainly is up for discussion we know when if you were to take a 35 five-year-old for example who was treated for a certain type of
cancer or for whatever reason you know in early ovarian insufficiency situation if you offer them hormones at the beginning they keep their risk of cardiovascular disease low they lower the risk of osteoporosis these women who go through an earlier menopause are increased risk of cardiovascular disease and are at an increased risk of bone loss so the question is always well if they come to you at 45 is it too late we have to weigh the pros and the cons and I would certainly consider the pros in a younger woman if a woman comes to me
in her 60s and is well beyond her final period we typically don't do that is there anything else that this woman could do 10 years out from menopause that would mitigate some of the symptoms of you know that that come from getting older and losing all your hormones so if she were to still have vasomotor symptoms which 10 15 of women still do there are non-hormonal ways in which we can address those symptoms it doesn't seem to me that this woman has symptoms I think she just is talking about the health benefits brain heart and
bone health if she doesn't really qualify for HRT are there things she can do that would benefit her brain heart and bone health yes yes yes yes yes so there are absolutely non-hormonal things one could do and one should be doing them even if one is on hormones being on hormones does not give one a pass in terms of taking care of their own health so eating healthfully is so important and having a heart healthy diet the Mediterranean diet for example very very important and also exercise and it's just not cardio a lot of women
think cardio alone is sufficient it really isn't especially as we age we lose muscle with age how much a year do you lose and muscle weight like a lot right look a decent amount and I will tell you I really try to emphasize to my patients especially the young ones who are doing Pilates and yoga and resistance resistance training I'm like keep doing it it is so important it's never too late to start
