Article taken from the front cover of the May/June Newsletter 2016 of National Women’s Health Network. Source: https://www.nwhn.org/hormone-risk-throughout-lifespan/
May 3, 2016
By Christina Cherel
Millions of women take hormones every day, and yet many don’t fully realize the risks. People often forget that the birth control pill, revolutionary, game-changing medicine, is in fact, a drug. In its early form, “the Pill” had such high hormone levels and negative side effects that women, and the women’s health community, protested — and succeeded in making it safer. Thirty years ago, women going through the menopausal transition were liberally prescribed hormone therapy not only to help with menopause’s unwanted symptoms but also as preventive care. Doctors prescribed and women took menopause hormone therapy without knowing the serious consequences of long-term hormone use, including increased risks of breast cancer and endometrial cancer, and stroke.
Today, we know that both hormonal contraception (like the Pill) and menopause hormone therapy do carry risks — and must not be exempted from the scrutiny we conduct on other drugs. In this article, we discuss hormone use over a woman’s lifetime, the risks from hormonal birth control and menopause hormone therapy, and how you can decide if taking hormones is right for you.
Hormone Use Throughout Women’s Lifetime
Many drugs that women use are indicated for a certain time in their lives. As women age and experience different stages of life, they may be more likely to use different medications and less likely to use others. For example, women in their teens and twenties may be more likely to use prescription acne medication. Bisphosphonates, which treat osteoporosis, are used primarily by women over age 60.
Hormones, however, are an exception. Many women are prescribed hormones like synthetic estrogen and progestin starting in their teens (in the form of hormone-based contraceptives), continuing through the menopausal transition (in the form of menopause hormone therapy), and even later years (in the form of estrogen therapy). It is worth noting that the formulation of estrogen in oral contraceptives and hormone therapy is different.
Some women may take hormone-containing medications for decades at a time without any breaks or without questioning these drugs’ risks. Drug manufacturers are notorious for “creating” diseases that warrant pharmaceutical intervention to encourage people to take more drugs for longer periods of time (and, ultimately, fill their own pockets). And yet, despite women’s common and often extended use of hormone-containing medications, many people often don’t consider hormones to be a drug the way that blood pressure medication or antibiotics are.
But hormones are drugs and, because they are prescribed and used by women throughout their entire life, it is especially important to know and understand their significant and sometimes life-threatening risks. While hormones are safe for the majority of people, women need information in order to make the best decision for their own unique health circumstances and preferences.
Regardless of the form or dosage of estrogen, or when hormones are taken over the lifespan, common side effects are similar: nausea, headaches, breast tenderness, and irregular uterine bleeding. Other serious side effects, like certain cancers, vary depending on how the estrogen is administered (orally or through the skin) and when and how long a person takes the hormones.
Hormonal Birth Control
Many women begin using a hormonal birth control method — like the Pill, patch, vaginal ring, or intrauterine device (IUD) — in their teens or twenties and may continue using it for decades to prevent or delay pregnancy.1 Many women also use hormonal birth control for reasons unrelated to pregnancy prevention, including relief from menstrual pain and excessive menstrual bleeding.2 The Pill is the most commonly used form of birth control internationally.3 Of the 62 percent of U.S. women of reproductive age currently using contraception, over a quarter of them (10.6 million) use the Pill.4
Many of us don’t think twice about using the Pill; it’s a symbol of revolution and freedom, for good reason. Hormonal contraception like the Pill has allowed women to take control of their reproductive lives in a revolutionary way, and has helped improve women’s social and economic standing immeasurably. This can sometimes mask hormone birth control’s negative side effects, and speaking out against the Pill can feel anti-feminist or anti-woman.5
But, when the Pill was first introduced, its high estrogen levels carried large health risks, which women’s health advocates helped expose (the NWHN was founded out of these advocacy efforts). As a result, today’s hormonal contraception is much safer, but there are still risks. Newer formulations of the Pill that contain drosperinone, like Yaz and Yasmin, carry even greater risks, and the NWHN asked the FDA in 2011 to take these versions of the Pill off the market. And, because hormonal birth control is so popular, even statistically small risks can affect a significant number of people in the general population.
Combined hormonal contraceptives (containing both estrogen and progestin) increase the risk of developing a blood clot. As a result of increased blood clot risk, hormones also increase the risk of heart attack and strokes. Some people with a blood clot don’t experience any symptoms, while others may experience swelling, pain, tenderness, skin redness, depending on the clot’s location. It’s important to seek immediate medical care if you experience any of these symptoms.
In fact, grassroots movements are increasingly springing up to warn young women about the often overlooked or dismissed risks of hormonal contraceptives (see: hormonesmatter.com, and birthcontrolwisdom.com). Prompted by the deaths of their own daughters, these activists have made it their mission to make women more informed about hormonal contraception and its risks.
Similarly, Holly Grigg-Spall and Ricki Lake are currently working on a documentary called Sweetening the Pill (based on Grigg-Spall’s book of the same name), which investigates how women got “hooked” on hormonal birth control and discusses non-hormonal family planning methods. Hormonal contraception is a vital part of many women’s reproductive health care, but they deserve to know that certain hormonal contraceptives have higher-potency hormones, and therefore carry slightly more risk.
Menopause Hormone Therapy
For many years, slick pharmaceutical ads marketed hormones to women as a “fountain of youth,” promising that taking estrogen would prevent wrinkles, reduce moodiness, and improve sexual responsiveness among menopausal or post-menopausal women. These claims were unfounded, misleading, and dangerous for women’s health.
Thanks to the federally-sponsored Women’s Health Initiative (WHI) — the largest long-term study of women’s health ever conducted — we now know that menopause hormone therapy carries serious risks. The WHI revealed that menopause hormone therapy isn’t as safe or effective as researchers, doctors, and drug manufacturers claimed. We also learned that, although menopause hormone therapy does help reduce the risk of bone fractures as long as you’re taking it, it doesn’t help prevent heart attacks and it does significantly increase the risk of developing breast cancer, blood clots, or stroke. As a result of women stopping hormone therapy, breast cancer rates have declined significantly in recent years. Using hormones for preventive care has decreased, but many women continue to use hormones to treat symptoms of menopause like vaginal dryness and hot flashes.
When used for the right length of time (less than two years) and at the right dose (the lowest possible), hormones can be an effective treatment for troublesome symptoms of the menopausal transition. But, we have learned that these benefits are not without risk. Thanks to the WHI, we now know that hormones don’t preserve or restore youth, improve memory, or prevent Alzheimer’s disease or heart disease. In fact, otherwise healthy women are more likely to experience heart attacks, blood clot, and stroke while taking combined estrogen/progestin hormones. Women’s bodies are not deficient during or after menopause and using menopause hormone therapy as preventive medicine rather than to treat symptoms will not help you stay healthy.
Managing Risks and Making the Best Decisions
Unfortunately, no one knows in advance whether a drug or device will cause an adverse reaction in her body. And there is no simple yes or no when it comes to the question, “Are hormones right for me?” We do know, however, that people may have certain predispositions that increase their risk of blood clots, such as genetic clotting disorders, overweight/obesity, smoking, and prolonged inactivity. We also understand that many people choose to use hormones despite these risks because of the many benefits they offer. It’s important to know the risks of any drug or medical device you’re using and work with your doctor to make the health care decision that best fits your unique circumstances. Knowledge is power — and hormone use is not an exception to the rule this time.
For more information on hormone use, check out the NWHN’s Fact Sheet.
Christina S. Cherel, MPH is the NWHN Program Coordinator.
1. Based on an average 2 children per woman and reproductive capacity 15-44 years of age; https://www.guttmacher.org/media/presskits/contraception-US/statsandfacts.html