When started during the perimenopausal years, hormone therapy (HT) slows down aging during menopause without increasing mortality risk, and the reduction was found to be most dramatic among women of lower socioeconomic status. According to the study published in JAMA Network Open, while hormone therapy may deliver benefits, it also carries increased risks for cancer, stroke, and dementia.
Phenotypic and chronological age discrepancies
This study utilized data from a cohort of 117,763 postmenopausal women who were enrolled in the UKBiobank to examine discrepancies between phenotypic and chronological ages to assess the rate at which they were again. 47,461 of the participants had used hormone therapy at some point.
Timing matters
According to the researchers, the analysis revealed that those who had used HT exhibited fewer indications of aging than those who had not. The strongest anti-aging effect was found among those who used HT starting at the age of 48.4 years for 4 to 8 years. While the anti-aging effect was more profound among those of lower socioeconomic status and the effect was less dramatic among those with higher incomes, those with higher incomes typically aged more slowly whether they used HT or not.
Perimenopause struggles
“A 48-year-old to 51-year-old woman is typically in a perimenopausal state, meaning they may not get periods every month. They don’t necessarily have consistent quality from egg to egg. From month to month, the estrogen production out of their ovaries is highly variable. On a low estrogen production month, they may start having vaginal dryness, vasomotor symptoms [ — such as hot flashes],” explained G. Thomas Ruiz, MD, board-certified OB/GYN and Lead OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, explaining what happens during perimenopause.
“They may not get a period for three months, and then when they do get a period, the bleeding may last for two to three weeks. So it really is a function of the ovaries getting in a situation where they’re just not working,” said Ruiz. Adding that the value of HT is “to help smooth their transition into menopause.”
Hormone therapy
“Women in their early 40s or younger may receive hormone therapy if they experience premature menopause, exhibit symptoms of premature menopause, or undergo a bilateral oophorectomy,” said First author Yufan Liu, of the Beijing Key Laboratory of Environmental Toxicology at Capital Medical University. Adding that “hormone therapy might help them to offset all-cause and cause-specific mortality associated with phenotypic aging.”
“Causations should be interpreted with caution. The findings also could be interpreted as an advantaged position regarding various health aspects in individuals with a high SES, so this population might not benefit from using HT,” Liu noted.
Bone health
“Within six months of the ovaries not producing estrogen, a woman starts to lose calcium from her bones at a more rapid rate than it enters. This ultimately leads to osteopenia and osteoporosis,” said Ruiz. “In your seventies and eighties [there] may be hip fractures, compression of the spine — kyphosis —humpback, and rib fractures. If an 80-year-old breaks a hip, the hip fracture may not kill her, but the recovery from the surgery and the consequences of surgery may.”
Hormone replacement therapy
Estrogen provides a woman with multi-organ system benefits. When a woman has hormone therapy after menopause it is called hormone replacement therapy (HRT). However, this should be accompanied by lipid testing to look for heart issues, and mammograms to screen for cancer, and lower doses of hormones are also recommended.
According to Ruiz, HRT can help to support bone health in menopausal women because “You have calcium continuing to enter the bone at a sufficient rate so that they don’t develop thinning of the bones — which is osteopenia or osteoporosis, or brittle bones.”
“The skin is filled with estrogen receptors — collagen— so the skin continues looking better,” he also noted. “The vaginal mucosa tends to maintain its normal appearance with a thick tissue.”
The HT controversy
This is not the first study to look at hormone therapy, the Women’s Health Initiative Study looked at the effects of HT in postmenopausal women and found that it significantly increased the risk of dementia and stroke and did not reduce cardiovascular risk.
The Nurses Health Study found that HT reduced the risk of dementia, however, two recent studies have found otherwise.
Data has been re-analyzed, and the consensus is that HT is helpful during perimenopause and may be helpful later, but it comes with definite risks.
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References/Sources/Materials provided by:
https://www.ncbi.nlm.nih.gov/books/NBK559235
https://www.nhlbi.nih.gov/science/womens-health-initiative-whi
https://www.acpjournals.org/doi/10.7326/0003-4819-133-12-200012190-00008
https://nyaspubs.onlinelibrary.wiley.com/doi/10.1196/annals.1347.004
