In some ways, this data was disappointing, as it did not support the “window of opportunity” theory that taking HT close to menopause maintains and benefits health. However, this theory does have evidence of benefit regarding women’s risk of cardiovascular disease, coronary heart disease, heart attack, and atherosclerosis.
Here at NAMS, we counsel that the decision of whether to take HT must be individualized for each woman, considering her overall health, severity of symptoms, quality-of-life priorities, and personal risk factors. We know that the risks of HT use in healthy women ages 50 to 59 are low. In older women, however, HT is associated with greater risks: A related WHI trial (WHIMS) found that HT use in women ages 65 to 79 caused a near doubling of rates of dementia, higher rates of cognitive decline over time, and decreased brain volume.
The bottom line of the new WHIMSY results is that younger women can be reassured that, if they choose to take HT for their symptoms, it will not harm their cognitive function or cause dementia.
In women ages 45 to 56 with regular menstrual cycles, about 55% have experienced vasomotor symptoms at some point, shows new research in Menopause. The cross-sectional study examined 1,513 women in the Pacific Northwest. Native American women were most likely to report vasomotor symptoms (66.7%), followed by black women (61.4%), and white women (58.3%). Asian and Hispanic women in the study were least likely to report ever having vasomotor symptoms (about 8% and 37%, respectively), similar to the patterns during the menopausal transition and early postmenopause.
Why would premenopausal women have hot flashes? As levels of estrogen go down in the body, numbers of hot flashes go up. Estrogen naturally declines as a woman gets older, especially at menopause. But estrogen levels can fluctuate enough to cause hot flashes years before menopause. Some women have hot flashes right after giving birth. Some may get them from intense exercise or from illness.
The relationship between reproductive status, general health, hormone levels, age, and vasomotor symptoms is complex and needs further investigation. But rest assured that it is perfectly normal to have hot flashes in the years before menopause. If you are still having regular cycles, these vasomotor symptoms do not necessarily mean menopause is beginning.
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JoAnn V. Pinkerton, MD, NCMP