A new analysis from Case Western Reserve University School of Medicine finds that women may be able to safely start estrogen therapy before menopause — potentially reducing symptoms such as insomnia and mood changes.
The research, co-authored by University Hospitals gynecologist Dr. Rachel Pope and medical student Ify Chidi, examined more than 120 million electronic health records and found that women who began estrogen treatment during perimenopause — the years leading up to menopause — did not have higher rates of breast cancer, heart attack or stroke than those who started after menopause.
Hormone therapy can help ease common menopause symptoms such as hot flashes, mood changes, brain fog and sleep problems. But the timing of treatment is critical. Research suggests that starting treatment within 10 years of menopause has lower cardiovascular risks and leads to better overall outcomes than beginning it later.
Pope, a menopause specialist at University Hospitals Cleveland Medical Center, said she wanted to know if it could be safe to start treatment even earlier for her perimenopause patients or even beneficial.
“Theoretically, I thought, and many of my colleagues think, that if you start earlier than that first 10 years [after menopause], you should have maybe even decreased risks, or certainly not higher risks,” she said.
The study compared three groups of women: those who started estrogen therapy during perimenopause, those who started after menopause, and those who never received hormone therapy. It found no significant difference in the rates of major health problems among those who began treatment earlier.
Pope said the research underscores the importance of spreading awareness, as she said many women don’t realize that menopause symptoms often begin years before their periods stop.
“We see mood changes, we see brain fog, we see sleep problems that aren’t related to hot flashes or night sweats, all of these things are tied to lower estrogen levels,” she said.
Pope said women should talk about these symptoms with their healthcare providers, as early conversations can help identify whether hormone therapy or other treatments could improve their quality of life.
While the report's results are promising, Pope cautioned that more clinical trials are needed before changing treatment guidelines.
