Take Charge of Your Health - HRT Update
Life doesn't end with menopause; it's the beginning of a new adventure.
Strap in and enjoy the ride.
- Helen Mirren, actor
Menopause affects 50% of our population and the symptoms can be life-changing and long-lasting. Menopause typically happens between the ages of 45 and 55; the average age in the U.S. is 52. It is preceded by perimenopause, a period of four to eight years when the ovaries slow their production of estrogen and progesterone reproductive hormones. This can cause erratic fluctuations in hormone levels and launch a cascade of symptoms that can continue into the postmenopausal years.
In the late 1990s, physicians thought they found the answer to the challenges of perimenopause and menopause through Hormone Replacement Therapy (HRT). Hormone therapy replenishes depleted hormones, particularly estrogen and progesterone. At that time, HRT was enthusiastically recommended to help women with their difficult symptoms including anxiety, mood swings, insomnia, night sweats, hot flashes, joint pain, and brain fog. In the ‘90s, nearly 15 million women in the U.S. were taking an estrogen-based menopausal treatment, making it the most commonly prescribed treatment in the country.
However, the popularity of hormone therapy dropped radically in 2002 with the publication of a report from the Women’s Health Initiative (WHI). The WHI clinical data indicated that women receiving HRT may be at increased risk for heart disease, breast cancer, blood clots, and strokes. More specifically, the analyses found that women who had been through menopause and were taking estrogen and progestin had slightly increased risks of breast cancer, heart attack, and stroke. Prescriptions for postmenopausal hormone therapy plummeted--from as high as 40% to below 5%.
Many physicians recommend starting treatment early in perimenopause to maximize the benefits and avoid complications:
Now, based on two additional decades of data, recent research indicates HRT can be a safe and effective treatment for menopausal symptoms, especially when initiated within a certain timeframe -- within 10 years of menopause or before the age of 60. While earlier studies raised concerns, particularly regarding breast cancer and cardiovascular disease, more recent analyses show that HRT, when started early, can in fact, offer significant benefits including reduced mortality and improved bone health.
The benefits of HRT for menopausal symptoms outweigh the risks for most women under age 60:
Today HRT is prescribed at lower doses and is shown to be safer. The progestin utilized in the initial WHI trial is no longer recommended. In its place, women receive a micronized progesterone, which has a molecular structure identical to progesterone produced by the ovaries, but with fewer side effects and no increased risk of breast cancer. To reduce the risk of potential blood clots, women can now receive HRT through the skin using a patch, cream, or gel instead of orally in pill form. HRT delivered through the skin does not metabolize in the liver and therefore, reduces the chance of blood clots.
Current research:
The current research and understanding of HRT supports that:
The timing of HRT initiation is crucial. Starting HRT early in menopause (within 10 years or before age 60) is generally associated with greater benefits and reduced risks.
Different types of HRT (estrogen-only, estrogen plus progestin, bioidentical hormones) have varying risks and benefits.
HRT is highly effective in managing the symptoms of menopause such as night sweats, hot flashes, and mood swings.
By increasing the level of estrogen, HRT can improve bone health, help prevent osteoporosis, and reduce the risk of fractures.
When started early (before the age of 60) or within 10 years of menopause, HRT can reduce the risk of cardiovascular events.
The risk of breast cancer is generally low with HRT, particularly with estrogen-only and when started early. However, combination therapy (estrogen and progestin) may slightly increase this risk.
Vaginal estrogen helps with vaginal dryness and does not increase the risk of breast cancer or blood clots.
After decades of misunderstanding, debate, and misinformation, today, updated research on HRT and potential risks are providing women with more knowledge and empowering them to make better, more informed decisions about menopause and their health.
Since research is ongoing, it is important to talk with medical professionals about the most recent data and results that are guiding the current clinical recommendations for HRT. Perimenopausal or menopausal woman struggling with symptoms should talk openly with their physician to help determine an individualized treatment plan and whether HRT or another non-hormonal medication is best given everyone's unique circumstances.
Open communication with a trusted healthcare provider:
When deciding whether to start HRT, it is crucial to consider risk factors, age, health status, medical history, and family history. Key considerations include:
Timing of HRT. This is critical. Greater benefits and reduced risks are associated with HRT when the woman is younger than 60 or within 10 years of the start of their menopause
The best type of HRT for the individual – ex: estrogen-only, estrogen plus progestin, bioidentical hormones, all need to be evaluated.
Hormone therapy can improve the quality of life for women experiencing severe menopausal symptoms. However, there are important considerations when determining the most safe and effective treatment plan so personalized medical advice is key when considering hormone therapy.