The Dutch Webinar Series: Menopause Myths and MHT

Speaker Introduction

• Dr. Tori Hudson: Naturopathic physician
  • Graduated from National University of Natural Medicine (1984)
  • Roles: Medical Director, Associate Academic Dean, Academic Dean
  • Adjunct professor at NUNM, SCNM, Bastyr University, and CCNM
  • Over 40 years in practice
  • Medical Director of A Woman’s Time clinic
  • Co-owner and Director of Product Research and Education for Vitanica
  • Program Director for the Institute of Women’s Health and Integrative Medicine
  • Founder and co-director of NARCR
  • Awards: 2020 American Botanical Council’s Freddy Cronenberg Award
  • Author: Women's Encyclopedia of Natural Medicine
  • Consultant and writer

Main Topics Covered

• Menopause myths and misconceptions
• Perimenopause
• Menopausal Hormone Therapy (MHT)

Common Myths and Misconceptions

• Childhood Myths: Examples include swimming after eating, shaving effects, wet hair causing colds, knuckle cracking causing arthritis, and the 8 glasses of water rule.
• Menopausal Myths:
  • Estrogen therapy causes breast cancer
  • Estrogen and progestogens significantly increase breast cancer risk
  • Screening mammograms must be done prior to prescribing MHT
  • Women should stop taking menopausal hormones by age 60
  • MHT can be initiated at any age
  • Progesterone cream is a sufficient delivery method for endometrial protection

Essential Studies on Menopausal Hormone Therapy

• PEPI trial, KEEPS study, Million Women Study
• Various WHI (Women’s Health Initiative) spin-offs
• Recent studies like REJOICE and REPLENISH

Position Statements and Consensus Guidelines

• North American Menopause Society (NAMS) 2022 Statement
• Position statements on non-hormonal therapy, genitourinary syndrome of menopause, osteoporosis
• Consensus guidelines on testosterone

Perimenopause and Menopause

• Perimenopause:

  • Defined as the time leading up to menopause with menstrual irregularity
  • Ends after 12 consecutive months without periods
  • Early transition: mostly regular cycles with interruptions
  • Late transition: prolonged amenorrhea (60+ days)

• Symptoms:

  • Change in menstrual cycle, vasomotor symptoms (hot flashes, night sweats), vulvovaginal symptoms (itching, dryness), sleep disturbances, psychological symptoms (depression, anxiety), joint and muscle pains, sexual dysfunction
  • Cultural differences in symptom prevalence

Menopausal Hormone Therapy Myths

• Estrogen and Breast Cancer:

  • Original WHI study showed a slight increase in breast cancer risk with Premarin plus Provera (progestin), but it's a minimal increase.
  • Estrogen-only therapy reduces breast cancer risk.
  • Estrogen and progestin increase the risk slightly but not mortality.

• Role of Progestogens:

  • Bioidentical progesterone may have less breast cancer risk than synthetic progestins.
  • Studies show no significant difference between Premarin and estradiol in terms of breast cancer risk.

• Screening Mammograms: Not required before initiating MHT but can be prudent.

• Stopping MHT by Age 60: No guideline mandates stopping at 60.

  • Continuation beyond 65 can reduce mortality, breast cancer, and other risks.

• Safe Initiation Age for MHT: Not safe to start systemic MHT after 60 or 10 years post-menopause.

  • Risks of DVT, stroke, cardiovascular issues are higher.

• Progesterone Cream for Endometrial Protection: Not sufficient, studies show inadequate protection.

Additional Myths and Points

• Vulvovaginal Estrogen in Breast Cancer Patients: Generally considered safe.
• Progestin vs. Progesterone Effects on Breast: Bioidentical progesterone has less risk than synthetic progestins.

Conclusion

• Importance of understanding myths and using evidence-based approaches in MHT.
• Resources and further reading available at DutchTest.com and related links.