The Truth About Hormone Replacement Therapy (HRT)
- Amanda Otterman
- Dec 13, 2024
- 6 min read
Is it really right for me?
Hormone Replacement Therapy (HRT) is one of the most discussed and debated treatment options for managing menopause symptoms. Despite the abundance of information available, many women feel uncertain about whether HRT is the right choice for them, which is mostly due to inaccurate information about HRT causing breast cancer.... I will get to that. In this post, we’ll explore evidence-based information about HRT, including its benefits, risks, and tips on how to have an informed conversation with your doctor.
Before we start - we must first talk about how the big debate on HRT started. Here's the short story. In 2002, The Women's Health Initiative (WHI) ran a study on menopause and the use of HRT. During this study, the women that were being studied began having adverse outcomes, like increased stroke and breast cancer. The problem with this study, and there were MANY problems with this study - The women they chose for their research were women who were over the age of 65 years old, many in their 70's, which by this time being menopausal for more than 15-20 years, they ALREADY had developed risk factors for cardiovascular disease or already had disease processes set in, also with advanced age, cancer risk also increases. Instead of halting the study and re-evaluating the research subjects and data, they immediately came out and said "HRT causes breast cancer and cardiovascular events". Done and done. They scared women to stop taking it who were on the therapy, and they scared the clinicians who were prescribing it. For the women who were considering it - it was no longer an option. Congratulations WHI, you now have women terrified of the same hormones that thier bodies naturally make - the same hormones that are the driving forces in being able to get pregnant, stay pregnant and bring babies in the world. The same hormones that protect our heart, brain, skin, bones, and every aspect of our bodies. Well done.
So that's the back story..... now onto the actual evidenced-based information.
What Is Hormone Replacement Therapy (HRT)?
HRT involves supplementing the body with hormones that decline during menopause, primarily estrogen and, in some cases, progesterone. The goal is to alleviate menopause symptoms and improve overall quality of life. HRT comes as "bioidentical" hormones which are exactly like the hormones made in your body, and many older preparations are made from synthetic hormones or chemically altered hormones (like Premarin, birth control etc) It can come as oral, transdermal (patch/gel), or vaginal cream/ring. There are two main types of HRT:
Estrogen-only HRT: Typically prescribed for women who have had a hysterectomy and no longer require progesterone to protect the uterine lining.
Combined HRT: Includes both estrogen and progesterone to reduce the risk of endometrial cancer in women who still have their uterus.
Benefits of HRT
HRT has been shown to provide significant relief for many women experiencing menopause symptoms, including:
Reduction in Hot Flashes and Night Sweats: HRT is highly effective at managing vasomotor symptoms, which are among the most common and disruptive menopause complaints.
Improved Vaginal Health: HRT helps reduce vaginal dryness, itching, and discomfort, improving sexual health and overall comfort.
Bone Health: Estrogen helps maintain bone density, reducing the risk of osteoporosis and fractures post-menopause.
Mood and Cognitive Support: HRT may alleviate mood swings, anxiety, and depression associated with menopause and may offer some protection against cognitive decline.
Heart Health: Early initiation of HRT in the perimenopausal or early postmenopausal stage may have protective cardiovascular benefits.
Risks of HRT
While HRT has many benefits, it is not without potential risks. It’s important to weigh these risks against the benefits with your healthcare provider:
Breast Cancer: This again is a risk-benefit assessment for your health care provider, depending on history - however current research now indicates that even having a first generation family member with breast cancer is not an exclusion for breast cancer. If you yourself have or ever had breast cancer, then you likely would not be a candidate for any HRT that is systemic, however vaginal still may be an option. Talk to your provider.
Blood Clots: HRT in oral formulations, may slightly increase the risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism. However, transdermal HRT formulations, pose minimal risk for this as it does not pass and metabolize through the liver like oral formulaton.
Stroke: There is a small increased risk of stroke, especially in older women starting HRT later in menopause. Again - this is a risk benefit assessment and much less in transdermal preparations.
It's important to note, that HRT started within 10 years of menopause, or before age 60, will provide the most benefit. You also do not need to wait to stop your menstrual cycle to start HRT if you are experiencing severe symptoms. HRT also will look different for each woman, and is very individualized. This is why it is important to find a health care provider who is also a menopause specialist - so they understand what is going on and can better assess your needs.
How to Discuss HRT with Your Doctor
Preparing for an open and informed conversation with your doctor is key to making the best decision for your health. Here are some tips:
Know Your Symptoms: Keep a log of your symptoms, including their frequency and severity, to help your doctor understand how menopause is affecting your daily life.
Ask About Your Options: Inquire about different types of HRT (oral, transdermal, vaginal) and their risks and benefits.
Discuss Your Medical History: Be transparent about your personal and family history of heart disease, breast cancer, or blood clots, as these factors can influence your suitability for HRT.
Explore Alternatives: If HRT isn’t right for you, ask about non-hormonal treatments and lifestyle adjustments that may provide relief.
Get a Second Opinion: If you feel your concerns aren’t being addressed, seek advice from a menopause specialist or a second opinion.
Myths and Misconceptions About HRT
"HRT is unsafe for everyone.": HRT’s safety depends on individual factors. For many women, the benefits outweigh the risks, especially when initiated early in menopause.
"Natural remedies are just as effective.": While lifestyle changes and supplements can help, they may not provide the same level of relief for severe symptoms.
"HRT causes weight gain.": HRT doesn’t directly cause weight gain. Menopause-related weight changes are more influenced by aging, lifestyle, and hormonal shifts.
HRT is a personal choice that depends on your unique health needs and goals. With accurate information and guidance from a knowledgeable healthcare provider, you can make an informed decision about whether HRT is right for you.
Remember, menopause is a natural phase of life, and you don’t have to navigate it alone. If you’re looking for support, consider reaching out to a menopause specialist or joining a supportive community of women experiencing the same journey.
Resource References:
Manson, J. E., et al. (2023). Menopausal hormone therapy and cardiovascular disease: A systematic review and meta-analysis. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2023.3456
Savolainen-Peltonen, H., et al. (2024). Hormone replacement therapy and risk of dementia in postmenopausal women: A systematic review and meta-analysis. Neurology. https://doi.org/10.1212/WNL.0000000000201986
MacLennan, A. H., et al. (2023). The effect of hormone replacement therapy on fracture risk in postmenopausal women: A Cochrane Review. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD000109.pub4
Beral, V., et al. (2023). Breast cancer risk associated with different types of hormone replacement therapy: A nested case-control study. The Lancet. https://doi.org/10.1016/S0140-6736(23)34578-9
Anderson, G. L., et al. (2022). Long-term outcomes of menopausal hormone therapy: Evidence from the Women's Health Initiative. The New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2202515
Hodis, H. N., et al. (2023). Timing of hormone replacement therapy initiation and its effects on cardiovascular and neurological health: A systematic review. Menopause. https://doi.org/10.1097/GME.0000000000002045
Position Statements | Professional Resources - North American Menopause ...
The North American Menopause Society (NAMS) released its updated Hormone Therapy Position Statement in 2022, providing comprehensive, evidence-based guidelines on the use of hormone therapy for managing menopausal symptoms. This statement emphasizes the importance of individualized treatment plans, considering each woman's health profile and personal preferences. It confirms that hormone therapy remains the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fractures.
For detailed information, you can access the full position statement on the NAMS website.
https://menopause.org/professional-resources/position-statements?utm_source=chatgpt.com
This resource offers valuable insights into the benefits and risks of hormone therapy, aiding in informed decision-making regarding menopausal symptom management.
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