The popularity of hormone treatments is increasing due to celebrities such as Caroline Tensen, Anita Witzier and Wendy van Dijk, and influencers who promote taking hormones. There are groups on Facebook of tens of thousands of women who exchange knowledge and experiences.
This Easter weekend, women across the country will be bringing Easter eggs to GPs because they ‘want their hormones back’ and believe that doctors are still far too cautious with the therapy.
The fact that combating menopausal symptoms with hormones is popular is evident from a run on progesterone, one of the prescribed hormones. The drug was even unavailable for a while.
According to gynecologist Dorenda van Dijken, menopause expert at the OLVG, general practitioners prescribe hormones much more often than before. Their previous guideline from 2012 stated that women with menopausal symptoms did not need to be treated. Hormone therapy has been recommended since 2022. “There really has been a breakthrough.”
Hot flashes
Serious menopausal symptoms can be remedied by taking hormones for a while or applying a patch to the skin. “If you’re sweating out of bed all night because of hot flashes, it’s clear: hormone therapy can help with this very effectively,” says Van Dijken, who set up the country’s first menopause clinic and is a member of several organizations that draw up medical guidelines for menopause.
From the age of 40, women produce less and less estrogen and progesterone: the menopause. Some women suffer from this a lot. For years, there was a strong aversion to hormones in the Netherlands, because a precursor to current drugs would drastically increase the risk of breast cancer. This emerged 22 years ago from a study that was later refuted, but resonated for a long time.
In the Netherlands, relatively fewer hormones are prescribed than in countries such as the United States and England. There, about 25 to 40 percent of women with menopausal symptoms receive the therapy. In 2019, the last time it was surveyed, this was only 5 percent of women in the Netherlands.
Now that this trend has been reversed, Van Dijken warns against extolling hormone therapy. “Now we suddenly have to give a lot of hormones. We’re going a bit crazy.” While hormones are really not the solution for menopausal symptoms for every woman, she says. “Some of it also has to do with behavior, nutrition and lifestyle.”
Risks
Because treatment with hormones does involve risks, the gynecologist warns. Long-term use puts women at greater risk of breast and uterine cancer. The higher the dose, the greater the risk. “It is best to prescribe for as short a period of time as possible, at the lowest possible dose. Although this is different for women who go through menopause before the age of 50. They can take hormones for longer,” Van Dijken explains.
She misses that nuance in the growing debate about hormones. “Things are said online that are simply not correct. Women read that and immediately believe it.” For example, women need to supplement their hormones for life. “That is not necessary at all. The transition is a temporary, unstable phase between two stable phases. The body adapts to this.”
What actually happens: there are receptors in the body – a kind of transmitters – that receive the estrogens and then let them do their work. It now appears that these receptors work less well as women get older. Van Dijken: “You can continue to take hormones, but after the age of 60 there is no point anymore because the receptors no longer do anything with them. And you do run a higher risk of cancer.”
Lifestyle and nutrition
So she prefers to look at women’s complaints and their lifestyle. There are foods that can worsen complaints, such as coffee, alcohol, spicy food, but also tea. “I had a woman who kept having hot flashes. I even increased the hormone therapy to see if the symptoms would improve, but that did not happen. What turned out? She drank a lot of licorice tea, which caused her blood pressure to be sky high.” The woman stopped taking licorice tea and got rid of her complaints.
Van Dijken recently had a patient in front of him who was convinced that she needed hormone treatment. “I said, I don’t think it’s your hormones.” She had blood drawn and guess what? The thyroid values deviated. “I have no idea about that, so she went to the internist and it turned out that she had something wrong with her adrenal gland.” Without hormones, but with treatment for the adrenal gland, this woman is doing a lot better. “As a doctor you have to be open to a broader view, not put on blinders.”
However, there is still room for improvement for women going through menopause, says Van Dijken. “I also see that not all doctors recognize the complaints. This applies to general practitioners, but certainly also to medical specialists. And I see that more often outside the Randstad. So yes, there is still room for improvement and in that sense it is good when women demand attention.”
Moreover, in America, women who have had depression in the past are more likely to receive preventive hormone therapy. During menopause, the risk of new depression is greater. “On that point we are really following the troops in the Netherlands.”
‘If you sweat out of bed all night because of hot flashes, hormone therapy can be very effective in controlling this’
