Over the last several decades, there has been misinformation and debate about the risks of Hormone Replacement Therapy (HRT). Let’s set the record straight and talk about why HRT could be a game-changer for you during your perimenopausal journey.
What is hormone replacement therapy (HRT)?
HRT is a medical approach designed to alleviate symptoms associated with hormonal changes, specifically during perimenopause and menopause. As our bodies undergo this transition, hormonal fluctuations can trigger a range of symptoms – from irregular periods, missed periods, and hot flashes to mood swings, weight gain and sleep disturbances. HRT restores hormonal balance, offering relief and improving overall short and long-term well-being.
Pros and cons of hormone replacement therapy
(spoiler: there are more pros than cons)
In the vast landscape of naturopathic and mainstream medicine, opinions on HRT vary. Let’s peel back the layers and explore why I firmly believe in the evidence-based merits of HRT for most women in this stage of life.
HRT primarily involves the replacement or supplementation of hormones that our bodies naturally produce but which decrease during perimenopause. The main players include estrogen, progesterone, and testosterone. The idea here is not to trick the body but to provide it with the hormonal support it needs to navigate this transition more smoothly.
Let’s talk about the benefits.
For women under 60 who are within 10 years of menopause onset and have no contraindications (a specific situation in which a medicine, procedure, or surgery should not be used because it may be harmful to the person), HRT is the most effective treatment for hot flashes and night sweats (which doctors call vasomotor symptoms or VMS) and bladder and vaginal symptoms like vaginal dryness, pain with sex, or increased urinary tract infections (which doctors call genitourinary syndrome of menopause or GSM).
And that’s not all. HRT has been shown to prevent bone loss and fractures – what you might know as osteoporosis and reduce the risk for death for all causes, fracture, and diabetes mellitus (DM). HRT also improves skin and eye health and improves sexual function including desire, arousal, orgasm, and pain. Estrogen therapy specifically has beneficial effects on skin thickness, elasticity and collagen (and what middle-age woman doesn’t want help with that?).
In short, for most women, there are more benefits than there are risks to using HRT to alleviate the symptoms we experience as we approach and go through menopause..
Now that you know all the pros, let’s address the safety concerns.
Contrary to what your mom may have told you, when administered under proper medical guidance, HRT is considered safe for most women. The key is personalized care. Ideally, we want to make sure you start it in a timely manner around perimenopause and that the approach aligns with your health profile and needs. Modern HRT formulations are designed to minimize risks while maximizing benefits.
The risks associated with Estrogen-Progestin Therapy (EPT) and Estrogen Therapy (ET) are low, but it’s true there’s a slightly heightened risk for blood clots, stroke, breast cancer and gallbladder (GB) disease.
Yes, those sound scary. Let me assure you—these risks are truly low, about 0.1% – 0.3% increase (1 additional case of breast cancer per 1,000 to 3 additional cases per 1,000) for certain types of HRT. There are factors to consider that can minimize those risks, which is why it’s important to work with a professional who takes a personalized approach and knows how to reduce risks based on you and your personal/family medical history.
For example, according to studies, the risk of gallbladder disease, including gallstones, inflammation, and surgery, is lower when administered through a patch (transdermal ET) than when administered orally.
Now, let’s address the risk that might be the scariest – the big “C” – breast cancer. The truth is the risk of breast cancer related to HT use is low. In fact, it’s about the same as the risks associated with drinking two daily alcoholic beverages, obesity, or not getting enough exercise.
Dispelling old myths about hormone replacement
Our mothers’ generation was sadly misled by a study conducted in the late 90’s and released in 2002 by the Women’s Health Initiative. The study implied that HRT had more detrimental than beneficial effects. The study received wide publicity, creating panic among some users and new guidance for doctors on prescribing HRT, resulting in a drop in HRT usage. Since that time, the study has been highly debated and it has come to light that there were several issues with the study including the age of the women tested (most were far past their final menstrual cycle), the progestin used for the study, and the misinterpretation of the results. But by the time the study was contested, the damage had already been done.
The book “Estrogen Matters” serves as a definitive guide to how and why the study was misinterpreted and inadvertently led our mothers astray. The pendulum swung – we hurt a generation and we’re still working to set the record straight. It’s a journey of evolution and learning from past misunderstandings and new science.
Qualities of a good candidate for HRT
Identifying the right candidate for HRT during perimenopause or menopause is like finding the perfect skincare routine – it’s personal. Typically, if you are a woman under 60 who is experiencing night sweats, vaginal dryness, changes in your menstrual cycle, or other symptoms described in this article, you’re probably a good candidate for HRT because this indicates you are within 10 years of menopause onset.
Even if you’re not entirely sure HRT is for you, it’s worth consulting a specialist like Dr. Kate to understand your options. There’s no reason to suffer through these hormonal changes when there’s a safe, effective, and true preventative option that could help you feel like yourself again. And if you do decide HRT isn’t the route you want to take, I can help you create a health plan using natural remedies.
Wrapping it up
In the end, it’s about finding a treatment that’s right for you, not fitting into a mold. HRT isn’t just a checkbox; it’s a personal journey that will continue to evolve. Even as you move through perimenopause, your hormones will continue to drop and your HRT or other treatment script might need a tweak, considering the pros and cons wisely.
This journey is about choices, conversations, and maybe a cup of herbal tea. If you’re ready to take the next step in your journey, reach out to schedule a visit, and let’s talk about what wellness looks like for you during perimenopause or menopause. Here’s to finding your hormonal harmony!
