Myths About Hormone Therapy (HT)

As a medical professional prescribing HT, you may need to combat the many misconceptions about hormone therapy. You may find it helpful to share the following information with your patients.

Below are just a few myths that you may be asked to clarify for your patients.

Myth#1: HT should no longer be prescribed.

Answer: As with all medications, there are risks and benefits to HT, which should be discussed with your patient on a case-by-case basis. Estrogen encourages the growth of some breast cancers and may be a problem for women with gallbladder or liver problems, blood clots or vaginal bleeding. However, for some women the risks may be outweighed by relief from moderate to severe menopausal symptoms.1

Myth #2: All HTs are alike.

Answer: While all hormone therapies have similarities, there are differences in dosage strength, delivery methods, administration, and frequency of dosing. Some therapies include a combination of hormones, while others are estrogen only.

Myth #3: HT is going to take care of all my patients’ symptoms.

Answer: Hormone therapy may not relieve all of the moderate to severe menopause symptoms. It is generally used to reduce moderate to severe vasomotor symptoms associated with menopause, and moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause.1 When prescribing hormone therapy solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered.

Myth #4: All menopausal women need the same combination of hormones.

Answer: Some women are fine without any therapy. Symptomatic, menopausal women without a uterus would be prescribed estrogen only. Those symptomatic, menopausal women who still have a uterus would likely be prescribed estrogen plus progestin. Without this additional hormone in their hormone therapy, women with a uterus are at higher risk for endometrial cancer.

Myth #5: HT causes weight gain.

Answer: HT does not cause permanent weight gain. Some women experience temporary weight gain due to water retention. Increasing fluid intake, limiting salt consumption and regular exercise help reduce water retention. A slowing metabolism, common as people age, should be accounted for in reduced calorie intake and regular exercise. CombiPatch® is not indicated for the treatment of weight loss.

Myth #6: Hormone therapy provides cardiovascular protection.

Answer: Hormone therapy does not provide cardiovascular protection.

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Estrogens and progestins should not be used for the prevention of cardiovascular disease or dementia.

The Women’s Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) during 5 years of treatment with oral conjugated estrogens (CE 0.625 mg) combined with medroxyprogesterone acetate (MPA 2.5 mg) relative to placebo.

The Women’s Health Initiative Memory Study (WHIMS), a substudy of WHI, reported increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 4 years of treatment with oral conjugated estrogens plus MPA relative to placebo. It is unknown whether this finding applies to younger postmenopausal women.

Other doses of oral conjugated estrogens with MPA, and other combinations and dosage forms of estrogens and progestins were not studied in the WHI clinical trials and, in the absence of comparable data, these risks should be assumed to be similar. Because of these risks, estrogens with progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.

Estrogens and estrogens/progestins combined should not be used in women with undiagnosed abnormal genital bleeding; known, suspected, or history of breast cancer; known or suspected estrogen-dependent neoplasia; active deep vein thrombosis, pulmonary embolism, or history of these conditions; active or recent arterial thromboembolic disease; liver dysfunction or disease; or known or suspected pregnancy.

In clinical trials with CombiPatch, the most common side effects were breast pain, dysmenorrhea, and headache.

1CombiPatch is indicated for women with an intact uterus for the treatment of moderate to severe vasomotor symptoms associated with menopause, and moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause. When prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered.