Not a light decision, according to this expert
Andrea Z. LaCroix, PhD, professor and chief of epidemiology and director of the Women's Health Center of Excellence at the University of California, San Diego, has specialized in the health of older women for more than 30 years. She's a lead researcher with the MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) Trials funded by the National Institute on Aging.
She's also a senior investigator for the Women's Health Initiative (WHI) program funded by the National Heart, Lung, and Blood Institute (NHLBI). She recently shared insights from her research with NIH MedlinePlus magazine.
What led you to study older women and menopause?
I started studying women's health many years ago as a public health nurse taking care of women. I did my dissertation at UNC-Chapel Hill on women's health, and I've always been interested in keeping women healthy.
In 1991 when NIH introduced the Women's Health Initiative (WHI), I felt it was a perfect fit for me. I said to myself, "Wow, that's a ship I have to get on." I was appointed as a project director and co-principal investigator for what was to become paradigm-shifting research when it comes to taking estrogen for menopause transition symptoms.
What drew you to your current research in the area of non-hormonal therapies for menopause?
In 2002, the WHI found that there were harms in hormone therapy and there was a compelling need for women to have alternatives. Taking oral estrogen around menopause or after was causing many more problems than we ever thought. Of course, there were nuances in those findings. But ultimately, we realized that taking menopause hormone therapy (MHT) wasn't just a little decision. It was a big decision, as it could affect many parts of your body.
Afterward, we had the opportunity to bring together a network of investigators from across the country to learn more about menopause treatment options. Our goal is to give women effective alternatives and have them ask the right questions. It's not to remove hormone therapy altogether.
Why is this research so significant for women's health?
WHI showed that hormone therapy may increase risks of many diseases like heart attacks, strokes, pulmonary embolism, breast cancer, and dementia in some women. The risks are greater for estrogen taken with progestin (synthetic progesterone) and for women over age 60. What it amounts to with breast cancer, if you do the math, is that estrogen plus progestin hormone therapy is linked to about 15,000 excess cases of breast cancer in the U.S. per year. To some, the increased risk is a small percentage of all treated women. To me, that's a large number.
It turns out that some of the alternatives we've tested work as well and sometimes even better than hormone therapy for improving menopause-related quality of life.
What research outcomes can you share?
Low-dose hormone therapy is the most effective therapy for reducing the number of hot flashes. But if the goal is improving quality of life, some alternatives work about as well as hormone therapy.
Among the most promising include escitalopram (an antidepressant medication) and cognitive behavioral therapy for insomnia, delivered by trained telephone counselors. Both of these interventions improve menopause-related quality of life about the same amount as low-dose hormone therapy.
MsFLASH research also showed that a specially designed yoga practice was effective at improving quality of life. Trials outside of the MsFLASH network suggest that hypnosis and mindfulness meditation are helpful as well. Thus, if women want to manage their menopause symptoms without taking drugs, there are effective options worth trying. This is especially true if improving quality of life, and not just reducing hot flashes, is the ultimate goal.
I'm 59, so I've had a very personal experience with the menopause transition and experienced hot flashes during the day and at night for over five years. Taking up yoga worked well for me. We're not talking about the kind where you put your leg behind your head. It's a restorative practice that includes slow movements or guided imagery. It's meant for cooling. Our research suggests that this type of yoga, and mindfulness in general, can be very helpful.
What is your advice to women facing the menopause transition?
I'd ask women to keep in mind that menopause is not a disease. It's a natural part of growing older.
Hormone therapy, at the lowest doses possible, may be appropriate for women if symptoms are really tough. But hormone therapy has risks, especially when used long-term or by women over age 60. My best advice is to be your own advocate and find out as much as you can about all of the options available to you, and then try the methods that feel like the best fit for you.
Find Out More
- National Institute on Aging:
- National Center for Complementary and Integrative Health:
- MedlinePlus: nlm.nih.gov/medlineplus/menopause.html
- Women's Health Initiative: www.nhlbi.nih.gov/whi/
- Clinical Trials: medlineplus.gov/menopause.html#cat27