Hormone replacement therapy with Dr. Glenn Keyes and the CHED Health Series

There are many reasons why a woman might need hormone support, but hormone replacement therapy is most commonly used to help women treat menopausal symptoms and protect their long term health. Copeman Healthcare physician Dr. Glenn Keyes discusses when you might need hormone therapy and what the best options are.

What is hormone replacement therapy? Does everyone need it?

Hormone replacement therapy is most commonly used to treat symptoms of menopause by replacing the female hormones estrogen and progesterone, which the body doesn’t make after menopause.

Does everyone need it? The short answer is no. It really depends on a woman’s individual preferences, the severity of her symptoms, her overall medical risk and other medical conditions.

This is why it is good to go someplace like Copeman because you can deal with each person individually.

At Copeman, I like to know a woman’s health really well prior to entering menopause. That would be the ideal situation so she’s well-informed of some of the symptoms and some of the treatments before she enters menopause. I’d just add as well whenever we’re talking about something like hormone therapy I like to let listeners know that I’m not making money from any drug company or anything like that. That’s a very important disclosure. I am not a pill pusher kind of guy. I make recommendations that are in the best interests of the patients and not everyone will need them.

Dr. Keyes, as a physician, how do you determine if someone could benefit from hormone replacement therapies or other related treatments?

Well, being able to build relationships and spend lots of time with my patients as we do at Copeman certainly helps open the line of communications, particularly for those who might be uncomfortable discussing some of the symptoms. For example, sexual discomfort due to vaginal dryness is very common, but a treatable symptom of menopause. And if a woman is not comfortable discussing these issues with their care provider she might never bring it up and continue to suffer needlessly. So something that I like to stress in my practice is open communication so that each patient is comfortable.

Most common for requiring treatment or the most common symptom a woman would seek treatment for hormone therapy would be the hot flashes and that seems to be the biggest threat to quality-of-life when it comes to menopause. Some women don’t get it at all, some get it mildly and some get it quite severely and it interferes with sleep and other essential functions.

Is there a specific age or could it happen anytime that some of these symptom start showing up?

The average age of menopause in Canada is about 50. More than 95% of women will enter menopause between 45 and 55. Sometimes the symptoms show up early before the periods stop so there is a time of a year or two where the symptoms can be particularly bothersome.

What are the treatment options? Are some better than others?

Absolutely, this is where an individualized approach is important.

There are oral forms of estrogen and progesterone, the two hormones that we look at to help with symptoms. The right one for you could depend on a number of things. If you’ve ever had a hysterectomy for example, combined estrogen progesterone therapy is not the one for you, but if the patient has an intact uterus, then it’s usually just plain estrogen. Estrogen can be given in pill form or it can be given in topical gel form that’s absorbed through the skin and then, as I mentioned, there are topical treatments for intravaginal use for the vaginal dryness.

What takeaways would you like to leave with listeners today?

Find a physician or a care team who you can build a relationship with, someone you can spend time with and who can address your concerns, explain your options and look at your individual risk profile. Walk-in clinics do a great job and they perform very important services, but that is not the place to go if you want to start this type of thing. You want somebody who really knows your medical history inside and out.

Just as an example, we used to use hormone replacement therapy to reduce cardiovascular risk. However, a lot more data in the last 10 years has come out to show us that’s probably not the best approach. This is really a symptom management thing and so your doctor needs to know your medical history and your cardiovascular risk. The last thing we would want to do is start someone on a medication that could help resolve symptoms, but actually puts your heart at risk.