Should I take hormone replacement therapy?

silver-haired womanMany of us, somewhere around the age of 50, find ourselves sweating profusely while screaming at our kids about shoes we just tripped over while searching for the handbag already our shoulder, trying to make it on time for an annual exam where our doctor will inform us that our bones are getting brittle.

Mood swings, brain fog, and osteoporosis can all be symptoms of menopause and peri-menopause. The low estrogen levels that come with menopause also come with a higher risk of heart disease, osteoporosis, and dementia.

Happily, there is a treatment that can temper your moods, help you remember why you entered a room, and even prevent osteoporosis. Studies show that hormone replacement therapy, also known as HRT, can mitigate each of these ailments. It even helps women live longer.

But you may be wary of HRT, and you would not be alone. In addition to the benefits, studies have also shown that HRT is not without risk, and it has gotten quite a bit of bad press in the United States. The largest HRT clinical trial to date, the Women’s Health Initiative, which enrolled more than 160,000 postmenopausal women from 50–79 over a period of 15 years, hormone replacement therapy (in this case an estrogen-progestin pill called Prempro) researchers reported that the treatment increased the risk of heart disease, stroke, blood clots and breast cancer.

That’s definitely not to be taken lightly, but the results also need to be put into context.

Listen to our podcast interview with Dr. Leslie Meserve to hear more about the risks and benefits of HRT.

In episode 16 of The Mean Show, Dr. Leslie Meserve helped me to just that.

“It had quite a few flaws,” she said of the WHI study, “and it really changed the face of women’s health care and the United States for the past almost 20 years. And it has been to our detriment.”

Back in 2002 when the Women’s Health Initiative reported findings, the researchers published a press release that said HRT could cause breast cancer, and it sparked a fear of the treatment that lives on to this day. But the press release was not exactly correct, Dr. Meserve said. There were just 8 more cases of breast cancer out of 10,000 “person years” (meaning both the number of people in the study and the amount of time each person spends in the study. For example, a study that followed 1,000 people for 1 year would contain 1000 person years of data.)

“It was not statistically significant,” she said. “That term statistically significant is important. We really shouldn’t be going to the public and saying there’s a finding if it’s not considered statistically significant, because without that being the case, it could be due to chance.”

Subsequent studies have shown that these risks are much more significant for women who begin hormone therapy when they are 60 or older, or more than 10 years after the onset of menopause. Researchers and doctors say that when you start HRT before 60 or within 10 years of menopause, the benefits actually outweigh the risk.

It also depends what type of hormone therapy you take. If you have had a hysterectomy (i.e. you do not have a uterus), doctors can prescribe estrogen alone, which has been shown to have fewer risks. If you have a uterus, however, your doctor will prescribe progestin along with estrogen because studies have shown that estrogen alone can build up the lining of the uterus and cause cancer.

Your health history is also a factor. If you have a family history or personal medical history of cancer, heart disease, stroke, blood clots, liver disease or osteoporosis, you should talk with your doctor about whether HRT is a safe choice.

If HRT does turn out to be a good choice for you, the benefits can be wide-ranging. HRT can mitigate symptoms in eluding the following:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Painful sex
  • Osteoporosis
  • Insomnia
  • Memory issues

Dr.  Phil Sarrel of Yale School fo Medicine has studied HRT extensively. In one study, he and his fellow researchers found that that 70% of women who experienced insomnia noted an improvement in their sleep, 56% noted an improvement in their memory, 42% said that they weren’t worrying nearly as much and 40% said they were able to perform more effectively at work.

Dr. Sarrel also found in 2014 that the decrease in women taking HRT after the 2002 study results led to women dropping out of the workforce as well as increased costs for medical treatments.

“Women who experienced hot flashes had 1.5 million more health care visits than women without hot flashes,” the study found. “Costs for the additional health care was $339,559,458. The cost of work lost was another $27,668,410 during the 12-month study period.”

As always, talk to your doctor about he best type of HRT and the delivery method that’s right for you. It can come in the form of a pill, patch, gel, vaginal cream, or slow-release suppository. Taking as little medication for the shortest amount of time can reduce the risks. Stay in regular touch with your doctor about how the treatment is going and how you’re feeling overall. And, as always, eat well and exercise to keep yourself healthy overall.

 

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