A change in lifestyle is now the first thing to consider in women who want to reduce their symptoms of menopause. This involves regular physical activity, eating a balanced diet, quitting smoking and moderating alcohol consumption.

Doctors have received new guidelines for prescribing hormone therapy, with the update of the Society of Obstetricians and Gynecologists of Canada (SOGC) Menopause Consensus Report.¹.

“We realized that for many women, hormone therapy had more drawbacks than benefits, and that it was not indicated for prevention,” explains D^r Serge Bélisle, head of the Department of Obstetrics and Gynecology at the University of Montreal.

D^r Serge Bélisle advises women who have no symptoms of menopause to abstain: hormonal therapy is not necessary. “They are not hormones of youth, and they are not indicated to prevent cardiovascular disease or osteoporosis. A healthy lifestyle and other specific measures, such as taking calcium and vitamin D supplements, are the way to go, ”he argues.

The Society of Obstetricians and Gynecologists of Canada asks physicians to assess the risks and benefits of hormone therapy on a case-by-case basis. The prescribed dose should be as low as possible. Prolonged use of hormone therapy, that is, for more than five years, may be suitable for some women, with periodic monitoring and evaluation.

This report marks a change of course. Doctors will no longer routinely offer hormone therapy, but as needed. The SOGC Expert Panel has taken into account the results of studies published over the past five years, including the Women’s Health Initiative²(WHI), which reported slightly increased risks of diseases (cardiovascular disorders, breast cancer) associated with taking replacement hormones.

Among the known risks associated with hormonal therapy, there is a slight increase in the risk of breast cancer after five years. For every 1 women who take hormone therapy for five years, there are two more cases of breast cancer than for every 000 women who have not taken any hormone therapy. Note that, according to the SOGC report, lifestyle habits have a much greater impact on breast cancer risk (see table below).

Breast cancer risk factors¹

* The usual, or normal, risk affects all women and is related to factors that cannot be controlled (for example, aging or gender).

Not in the dock

D^re Sylvie Dodin, gynecologist and holder of the Lucie and André Chagnon Chair for the Advancement of an Integral Approach to Health at Laval University, is not surprised by the new directions taken by the Society of Obstetricians and Gynecologists of Canada. “This consensus is entirely in the same direction as two other consensuses, Canadian and American, namely that hormone therapy remains the best indication for women who are very symptomatic, and whose quality of life is disturbed”, specifies- she does.

According to D^re Obviously, it is desirable that priority be given to lifestyle habits, which are crucial for improving quality of life and preventing long-term illnesses. But, at the same time, she warns against the tendency to dramatize the taking of hormones. “After the publication of the WHI study, some women felt guilty about taking hormones,” she adds. However, a woman who does not sleep well, who has many hot flashes, who wakes up exhausted in the morning, will suffer every day. What is more, she will not exercise, will not have the courage to prepare good meals and, therefore, will increase her risk of disease. In this case, hormone therapy remains indicated. “

In Quebec, about 20% of women use hormone therapy to reduce hot flashes, night sweats, vaginal dryness, sleep disorders and low libido. Before the publication of the WHI study in 2002, 30% to 35% of Quebec women were taking hormone therapy.

In addition to adopting better lifestyle habits, women can also turn to non-hormonal treatments to reduce their symptoms. For example, the use of antidepressants, antihypertensives, anxiolytics or lubricants can be useful as needed.

Regarding alternative and complementary medicine, although cautious, the SOGC displays a certain openness. It recalls that data relating to their effectiveness and safety are scarce. According to her report, black cohosh, red clover and soy isoflavones, vitamin E and acupuncture may help manage some symptoms when they are mild.

Gynecologist Sylvie Dodin considers this a step forward. “The Company recognizes that alternative and complementary medicine are among the approaches to consider with patients,” she says. According to her, complementary approaches can be put on the same level as hormone therapy in women with little or moderate symptoms.

The most effective options would be soy phytoestrogens and black cohosh, in her opinion. (On this subject, you can consult our files, in associated documents.)

The most recent update of the Society of Obstetricians and Gynecologists of Canada (SOGC) Menopause Consensus Report, first published in 1994, was in 2002.

Marie-Michèle Mantha – PasseportSanté.net

Sheet created on: February 13 2006