If you’ve talked with anyone about the Big Change, especially your doctor, the subject of hormone replacement therapy for menopause was probably one of the first things that came up. Why? Because replacing your depleting hormones can be a great way to tell your menopausal symptoms who’s boss. If, however, you’ve looked into these types of medical treatments, you’ve probably experienced information overload, with some of that overload reading, “see error message, not all good news.”
Whether you have or haven’t experienced the hormone replacement therapy (HRT) overwhelm, let me set the record straight so you can decide if hormone replacement therapy for menopause is right for you. The long and short of it is that, as with every other approach to treating menopause signs and symptoms, HRT has its pluses and minuses. Much of these pros and cons depend on your individual circumstances, which is why it’s good to both talk to the pros and be proactive. This treatment indeed works better for some perimenopausal or post-menopausal people than it does for others. So time to put on your proactive panties, make some “me time,” decide which treatments best support your symptoms, and take action!
What Is Hormone Replacement Therapy (HRT) for Menopause?
First off, you’ll hear both hormone replacement therapy (HRT) and hormone therapy (HT) used interchangeably in any book or blog post you read about how to alleviate your menopausal symptoms. HRT was the preferred way of referring to the use of supplemental female hormones to treat menopausal symptoms, according to the Mayo Clinic, for decades. Some practitioners now prefer to call it HT because they believe “HRT” denotes that the female body is deficient and needs to be fixed with substances not found in nature. Both HRT and HT, however, refer to the same thing: helping your body make peace with your declining hormone levels so that you can, y’know, function, and even thrive.
Although HRT/HT began back in the 1940s, science didn’t clue in to the need to study its effects until the mid 1970s. Then, all sorts of studies began, most of them very large and involving hundreds of thousands of women. You would think that, with those kinds of numbers, the findings of those studies would’ve shown by now whether HRT/HT was conclusively the best way to treat vaginal dryness, hot flashes, and the like. Not so much. Studies are STILL ongoing. That’s the thing about science, just like our bodies, it’s always evolving.
The Women’s Health Initiative (WHI) ran a study that was the largest randomized controlled trial to date of the effects of HRT/HT on menopausal symptoms. Dr. Tara Allmen, author of Menopause Confidential, calls this study The “King Kong of all confusing and misunderstood women’s health studies” and says, “whether you realize it or not, the WHI is the reason so many of you are frightened to start therapy.” Its purpose was to study the effects of hormone therapy on heart attacks, stroke, blood clots, bone fractures, breast cancer, colon cancer, uterine cancer, etc. The more scientists re-analyze the WHI data and examine the data from other long-term, still-going-on studies, the more they realize that the risks and benefits of HT depend a lot on the age you are when you join the Menopause Club, when you start hormone therapy, which treatment you choose, whether you have a uterus, and how long you use HT.
The North American Menopause Society says that the benefits of HT outweigh the risks for women who begin HT close to menopause. What that means is that there are risks, but they depend on so many factors—your age, medical history, whether or not you still have a uterus, where you’re at in your menopausal transition, your symptoms, etc. That means that you yourself could get a lot of relief from your menopausal symptoms without necessarily putting yourself at risk of all the downsides of HRT/HT, which I’ll explain below.
The best candidates for hormone therapy are healthy cis women who are suffering from menopause symptoms, less than 10 years from their last menstrual period, and under the age of 60 when they begin treatment.
What Are the Types of HRT/HT?
This has been the most-prescribed form of HT for decades, primarily for women suffering from hot flashes, vaginal dryness, and mood swings. Declining estrogen levels, particularly in the late stages of the menopausal transition, is at the heart of vaginal dryness. So, if that’s your only symptom or main complaint, this might be what you want to try first. For some (lucky) women, estrogen is all they need.
A decline in progesterone is usually one of the first signs that the menopausal train is pulling into the station. But, since progesterone and estrogen have a VIP (Very Important Partnership), this decline makes estrogen think it needs to take over when progesterone isn’t pulling its weight. that doesn’t do anybody any good, so just progesterone therapy may be needed to restore that partnership to harmony.
This is the one you’ll want to take if declining libido is your main symptom and your testosterone levels are low. Topical testosterone, meaning the kind administered either through a patch or a gel applied to the skin, has been shown to be particularly effective in increasing desire in postmenopausal women. One caveat: of the three main hormones that play a role in menopause, the effects of just-testosterone therapy have not been studied as extensively. So, while it appears to be safe, more long-term studies are needed to fully assess its safety and side effects.
For some people, a combination of estrogen and progesterone (progestin) is the go-to prescription, primarily because this combination reduces the risk of uterine cancer in people who still have their uterus.
Most of these kinds of hormone therapy are available in pills, patches, creams, sprays, tablets, or gels. There might be more ways to take hormone therapy than there are kinds! (Isn’t is great living here, in the future, with all these options?) Note that some practitioners prefer synthetic to bioidentical (i.e., hormones that are molecularly identical to the ones our bodies make…or made, although they’re technically also synthetic because they’re made in a lab) or vice versa. Check out some of the sources listed below to get yourself educated about those options and that debate.
Are There Ways to Alleviate My Symptoms Without Hormones?
Yes! You may be surprised to find out that HRT/HT isn’t your only option for addressing your symptoms. Depending on your personal preferences and circumstances, the severity of your symptoms, and other factors, you may want to consider trying other options first. If they work for you, then great! If they stop working after a while, or aren’t as effective as you’d hoped, then it might be time to involve your doctor.
Your options for alleviating your symptoms without HRT/HT fall into two categories: the non-hormonal medicines category and the totally natural, I-don’t-want-to-have-anything-to-do-with-prescriptions category (yes, I just made up that name). Medicines like gabapentin and clonidine, which I mentioned in this post on medical treatments for menopause symptoms, can be handy for alleviating symptoms as well as preventing migraines and lowering blood pressure.
If you want to go totally au naturale, which is to say, use natural ways to support your body in its best efforts to supply as many of the big 3 as possible for as long as possible, a smorgasbord of these options are what you need to look into:
- Regular exercise
- A hormone-balancing diet like the one Dr. Snyder details in her book The Essential Oils Menopause Solution (can you say “yum?” And also, “Holy cow! I had no idea that the foods I ate could have such an effect on my symptoms!”)
- Essential oils
What Are the Pros and Cons of Hormone Replacement Therapy for Menopause?
As mentioned, HRT/HT can be a miracle worker for some people, especially when natural supplements and other methods of alleviating symptoms fail to do the trick. But, it isn’t for everyone. Regardless, as Dr. Christiane Northrup says, “There is no magic bullet, one-size-fits-all hormone prescription or drug regimen of any kind that is right and healthy for all or even most women to take indefinitely. And because each of us is an individual with differing needs, constitutions, beliefs, and environments, there never will be—no matter how many studies are done.” Womp womp, womp. On the plus side, one more way we get to express our individuality, right? Consider the pros and cons of hormone replacement therapy for menopause, then talk about them and your needs with your doctor. One fun thing to note? It appears that only studies with really nifty acronyms are the only ones you should care about.
Pros of HRT/HT
- The Nurses Health Study (NHS) conducted, interestingly enough, on thousands of female nurses, showed that HRT/HT reduced risk of colon cancer and hip fracture. In fact, it also found that, when started early in menopause, HRT/HT is also associated with a reduced risk of heart disease. This study began in 1976 and is still going on today.
- The Postmenopausal Estrogen/Progestin Interventions Study (PEPI) ran for three years between 1987-1990. It was a randomized, controlled trial, meaning that the 800 healthy women ages 45-64 were randomly assigned to either a treatment group, where they received actual HRT/HT, or a control group, where they received a placebo. This study’s purpose was to find out the risks and benefits of various hormone therapy regimens on heart disease and bone health, and it discovered a good number of significant benefits:
- Hormone therapy increases bone mineral density in the hip and spine.
- Hormone therapy does not cause weight gain (whew!).
- Hormone therapy lowers the risk of heart disease by increasing good HDL cholesterol and decreasing bad LDL cholesterol. This was also confirmed in another large study called the Heart and Estrogen/Progestin Replacement Study (HERS), which ran from 1998-2002.
- The WHI study showed that HRT/HT was also associated with a reduced risk of hip and spine fracture and colon cancer.
In other words, in many people, HRT/HT not only does the trick but also provides other health benefits.
Cons of HRT/HT
- Both the NHS study and the WHI study showed that hormone therapy used for longer than five years is associated with an increased risk of breast cancer and stroke. HRT/HT in people with a uterus is associated with a modest increased risk of breast cancer when used for longer than five years.
- Both the HERS and WHI study showed an increase in the risk of blood clots in veins and lungs.
- They also showed an increased risk of gallbladder disease.
- HRT/HT is associated with increased risk of heart attacks.
If this sounds scary (and it’s understandable if it does!), keep in mind that an increased risk does not mean you for sure will develop any of these problems, but your chances do increase somewhat on HRT/HT. If you would like more information on any of these studies, Dr. Northrup’s and Dr. Allmen’s books are good resources.
It’s a Wrap!
Keep in mind that the goal of HRT/HT is not to help you time travel back to your pre-menopause days (if only we lived in the age of Star Trek, eh?), but to help you glide into middle age sagely and with grace. When you look at it that way, HRT/HT becomes not only a way to relieve your menopause symptoms, but also another “book” in the “library” of your mind, knowledge from which to draw when you need it most.
No one says it’s magic, and, in fact, the FDA recommends that hormone therapy be used at the lowest doses for the shortest time needed to achieve treatment goals, which will be different for every person. Just like with cilantro in a recipe, or advice from your mother-in-law, less is more. It can, however, be a saving grace.
Know your options, talk to your healthcare provider, understand the pros and cons of hormone replacement therapy for menopause, and pick the option that is best for you. You are in the driver’s seat on the road to rocking midlife.
- Allmen, T. (2016). Menopause confidential: A doctor reveals the secrets to thriving through midlife. HarperOne.
- Faubion, S. (2016). The menopause solution: A doctor’s guide to relieving hot flashes, enjoying better sex, sleeping well, controlling your weight, and being happy! Oxmoor House.
- Northrup, C. (2021). The wisdom of menopause: Creating Physical and Emotional Health During the Change (4th ed.). Bantam.
- Snyder, M. (2021). The essential oils menopause solution. Rodale.
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