Guest Opinion: Hormone Replacement
Therapy: Should I or Should I Not?
The topic of menopause and how/if we treat associated symptoms varies greatly among practitioners. Hormone replacement therapy has gone in and out of favor over the years but remains the most effective treatment for the majority of symptoms experienced. There was a recent article in The New York Times by Susan Dominus that goes through the history of hormone replacement therapy use and how it has come to be such a controversial and misunderstood subject. It is worth a read (or a listen on The Daily). HRT is not risk free and the pros and cons should be weighed carefully. This is a topic of great interest to much of my social circle and one that I have been discussing with women for the last 20 years.
So, to answer some questions posed by patients and friends alike:
What are the symptoms of peri-menopause/menopause? Hot flashes, night sweats, erratic menses, weight gain, mood swings, sleep disturbances, vaginal dryness, lowered libido and memory changes are the most common symptoms. There are some lucky women out there that stop their menses and never have symptoms, but they are the exception. There are also times when these symptoms can occur without being associated with menopause.
What are the risks of HRT? Breast cancer, blood clots and stroke are the main risks of concern, but these risks are proving to be less than originally thought. Some, but not all, of these risks can be reduced with managing how HRT is administered to each individual. Delivery method, age of patient, medical history, family history all need to be looked at closely to maximize benefits while minimizing risk.
When should I take HRT? The average age that a woman stops menstruating is 51. Most women are having menopausal symptoms several years before this. HRT is best started before the age of 60 or within 10 years of stopping menses.
If I start HRT, how long am I taking it? However long it is needed to continue providing the benefits you need it for. Generally, it is recommended to be off HRT by age 65. Again, this is decided together with your provider after weighing risks and benefits.
What is a bio-identical hormone? Bio-identical hormones are prescriptions that are chemically identical to what your body makes. Many of the options available to us are bio-identical whether from a conventional or compounding pharmacy. There are some synthetic hormones still used but not very often anymore for women (birth control being the exception).
Not everyone needs to take HRT. HRT should be used to improve quality of life if needed with the minimal amount of risk and maximum benefit.
Both the beauty and confusion concerning treatment of menopausal symptoms lies in variation of treatment options. HRT is not the only treatment out there that can help ease these symptoms. There are both conventional and alternative non-hormonal treatment options available. Be sure to consult with your medical provider or find one that is open to having a detailed conversation about this inevitable transition in your life.
—Dr. Azure Karli is a naturopathic physician and owner of
Bend Naturopathic Clinic.
Guest Opinion:
The Needs of Women Veterans
As a Marine of the Iraq war era, I experienced the unique challenges women veterans face reintegrating into civilian life. Military service during an era of extensive wartime operations carries a weight not well understood by the general public, and this is a major contributing factor to feelings of isolation and disconnection from community. Add demands of professional pursuits, family obligations and often a lack of an established local network of friends and family, and it’s clear that the need for support and resources is substantial.
It’s easy to assume that someone with a high level of emotional resilience and distress tolerance can operate well without a support system. Maybe for a limited duration. However, everyone needs community and connection — everyone — even when we don’t recognize that we do. In 2010, Brené Brown gave a now-famous 20-minute TED Talk, “The Power of Vulnerability,” garnering over 35 million views on YouTube. Trained to eliminate vulnerability, veteran women are wearing an immense amount of armor, built from a culture that normalizes and emphasizes toughness and self-sufficiency. We often lack the acknowledgement that we even have distress, the emotional comfort to engage in social self-advocacy to ask for support or connection, and an attunement to our own body cues of stress and pain. Meanwhile, we are struggling for a sense of purpose, meaningful connection with others and desire for belonging within our new community. This can happen for men too, but the resources are far behind for women veterans who need support.
It is crucial to provide women veterans with opportunities to connect with peers and find true friendships within the community. Isolation and disconnection have significant impacts on our mental health and wellbeing. According to 2022 U.S. Census data, over 7% of our Central Oregon population are veterans, approximately 18,235 individuals, and of those roughly 1,500 are women. In our region, women veterans are two-and-a-half times more likely to commit suicide than civilian women of their same demographic (almost twice the same statistic for male veterans). Connecting with other veterans — especially other women with shared lived experiences, provides a sense of camaraderie and support that is desperately needed among our minority population.
As the Director of Development at the Central Oregon Veterans Ranch, I am proud to be part of an effort to address these needs. We are further extending our agri-therapy programs and peer support networks, providing a safe and supportive environment for women veterans to connect with other veterans. We don’t have to feel invisible in our community. This is especially important for those who may not have family or friends nearby, or who feel isolated due to unique wartime experiences or underlying traumas.
I urge everyone in Central Oregon to come together to build a more inclusive and welcoming atmosphere among us all. We must recognize that expressing vulnerability and seeking help is a sign of strength, not weakness, and support and deep connection are essential for a thriving life outside of the military.
— Lauren Grigsby, Director of Development, Central Oregon Veterans Ranch
Letter of the Week:
For this week’s Women’s Issue I asked the two
women above to write on a topic of their choice. Thus, Letter of the Week is on
pause for this special issue!
—Nicole Vulcan
This article appears in Mar 1, 2023 – Mar 13, 2024.
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