Menopause

Let’s Talk About Hormone Replacement Therapy (HRT)

The history of hormone replacement therapy (HRT) is long and controversial. There are pros and cons to HRT, and it’s not right for everyone, but some women who could benefit from HRT haven’t been prescribed HRT due to an outdated study. Let’s dig into it—and find out if HRT could be right for you.

During menopause, estrogen levels drop, and most women experience uncomfortable symptoms like hot flashes and night sweats, vaginal dryness, and painful sex. Some people don’t find the symptoms troublesome or are able to manage with lifestyle changes, while others feel their lives are severely disrupted.    Hormone therapy for symptoms of menopause and perimenopause is also known as hormone replacement therapy (HRT) or menopausal hormone therapy. The first clinical trials on HRT started in the US in the late 1990s. Early results showed HRT was more detrimental than beneficial, and created widespread panic among the public, especially among those on an HRT regimen. In years following, there was a reanalysis of the original HRT trial, and new studies showed the use of HRT in younger women, or early postmenopausal women, had a beneficial effect on the cardiovascular system, reducing coronary disease and all-cause mortality. Given its complex history, HRT remains a controversial topic among the medical community, but the reality is: HRT can be beneficial for some women. Every patient’s situation is unique and should be treated as such.    Medication that provides estrogen can relieve symptoms either systemically in your whole body by taking pills or using patches or by applying it locally for vaginal dryness.  There are pros and cons to HRT and it’s not right for everyone, but some women who could benefit from it have not been prescribed HRT. Let’s take a closer look.
  • What are the benefits of hormone therapy? Systemic hormone therapy has been proven to be the best treatment for hot flashes and night sweats, either with or without progestin.  Both systemic and local hormone therapy relieve vaginal dryness and painful sex.  Research also indicates systemic estrogen helps protect against the bone loss that occurs during menopause, helping prevent osteoporosis.  Combined hormone therapy (estrogen and progestin) may reduce the risk of colon cancer.  
  • What are the risks of HRT? Estrogen-only HRT causes the uterine lining to thicken, which increases the risk of endometrial cancer.  Therapy which adds progestin decreases this risk.  Combined hormone therapy is associated with a small increased risk of breast cancer and also with a small increased risk of heart attack for older women, according to the American College of Obstetricians and Gynecologists (ACOG).  Both types of hormone therapy are associated with a small risk of blood clots and stroke from deep-vein thrombosis (DVT).  This risk increases with age, obesity, kidney disease, and heart disease. Some research suggests combined hormone therapy may protect against heart attacks in women who are younger than 60 years and start therapy within 10 years of menopause.  More research needs to be done, and combined hormone therapy should not be used only to protect against heart attacks.  Recent research has determined that the risks of HRT are low for healthy women younger than age 60 or within 10 years from menopause.  It’s important to take the lowest effective dose for yourself, for the shortest period of time that you need it.
  • How do you receive hormone therapy? Estrogen is available as pills, patches, or topical gels, creams, or sprays.  Vaginal estrogen comes as a cream, vaginal ring, or vaginal tablets.  Progestin comes in pills or on intrauterine devices (IUDs). 
  • What are the side effects? Side effects can include bloating, breast swelling or tenderness, vaginal spotting or bleeding, and headaches.  Talk to your doctor if these symptoms bother you or last longer than expected when starting hormone therapy.
  • Who shouldn’t receive hormone therapy? Systemic hormone therapy is not recommended for anyone who has had breast or endometrial cancer, stroke, heart attacks, blood clots, or liver disease.  If you get pregnant or think you may be pregnant, stop taking hormone therapy.  It is not safe for pregnant women.
 
  • How can I decide if HRT is right for me? Start by reaching out to your WIN Nurse Care Advocate. They’ve undergone special training to become menopause experts and can help you identify your symptoms, talk through your options, and refer you to a menopause specialist best suited to treat your condition. To help streamline the process, we recommend compiling your medical history, your family history, and make note if you’ve ever had complications with taking birth control pills. In some cases, this can inform the decision if you’re a candidate for HRT. 

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