Instead, let's give them through the skin or through the vagina for women at particular risk. Preparations are available for all alternative routes, all of which avoid the liver and decrease blood clotting risk.
So again I ask, why don't we give more women hormone replacement therapy, essentially as a routine, unless there are specific reasons not to? Right now, no more than 20 percent of post-menopausal women in this country take hormone replacement.
If low thyroid were the issue, a doctor would prescribe, and the patient would take, supplemental thyroid hormone. If diabetes were the issue, a doctor would prescribe insulin (or a substitute drug). There would be none of this dithering and bargaining. The same should be said for ovarian hormone deficiency
When menopausal female patients have insomnia, and depression, why do doctors prescribe sleeping pills or anti-depressants when hormone replacement works wonders for these complaints?
Another clear fact shown by all studies is a definite deadline by which hormone replacement must be started. It is absolute that to be significantly effective the hormones must be started with menopause or very soon after. Do not wait. Start with the hot flashes and keep going. Women, who don't do this, will have time for regrets when it is obvious their body is weakening, but in all likelihood it will be too late by then. Remember, it is preventive medicine.
The main reason for the low usage of hormone replacement therapy is that it is "not natural." Of course, it doesn't help that the results are in the future, and one has to be in the plan-ahead mindset. We're not talking about instant gratification except in eliminating menstrual irregularities and hot flashes.
Here is what is natural: A hundred years ago (and for all time before that) women died routinely in childbirth and of all the rampant diseases and traumas of past history. At that time pneumonia was almost always fatal, tuberculosis was rampant, and any significant trauma was likely to be deadly because sterility and anesthesia were unknown. There's a reason why stepmothers were famous in fairy tales. So few women reached old age it didn't matter if hormone replacement therapy was unknown and unavailable.
If that makes you nostalgic, forget about hormone replacement therapy. But if you think you might want to be a healthy oldster, consider the information I have shared and please don't wait until you're 70 to begin. Talk with your provider about starting hormone replacement therapy when your periods really get irregular, continue it thereafter, and enjoy your old age.
Haning is physician in Charleston.