Hormone replacement therapy, or HRT, has gotten a seriously bad rap over the last two decades. Confusing studies, reexamined data, and general bafflement over whether it’s helpful or harmful has caused millions of women all over the world to stay away from it.
“We are finally using scientific method and good studies to understand the benefits and risks of HRT. This has been long in coming,” says Lizellen La Follette, a board-certified OB-GYN in Marin County, California. “I welcome and anticipate better research about HRT and its impact on heart disease and stroke, the leading causes of death in women.”
In the last two decades there’s been a lot of confusion about HRT, scaring off patients and their health care providers. In 2002, the world of health care was nearly spun off its axis when researchers said that HRT increased the risk of breast cancer and blood clots.
La Follette said it caused “fearmongering” around breast cancer and instilled the idea that no woman should receive HRT for menopause symptoms.
“The data wasn’t statistically robust,” said La Follette. “The information they gave women was wrong.”
Now, in 2022, more and more medical professionals and researchers are strongly recommending that women with an all clear from their health professionals consider HRT instead of suffering from their menopause symptoms.
We have more research than ever about HRT. But that doesn’t mean we don’t need more. Until we get there, how can you tell if it’s the right treatment for you? Ahead, everything you need to know about HRT for menopause.
What is hormone replacement therapy?
During the journey from perimenopause to menopause, your body will go through a laundry list of changes as it adjusts to your fluctuating hormone levels.
The bountiful hormones that existed in vast amounts begin to decrease as you pass your childbearing years — this can vary, of course — and they’ll continue to dwindle for the rest of your life.
“During the menopause transition, levels of the hormones that your ovaries normally produce begin to fall,” says Somi Javaid, a board-certified OB-GYN. “Changes in these hormone levels can cause unpleasant symptoms.”
We all have different philosophies and approaches toward the manifestations of (peri)menopause. Some can push through annoying symptoms by making simple lifestyle tweaks, while others find it harder to cope with issues that impact their daily functioning. HRT — estrogen or both estrogen and progesterone — is a common treatment option that alleviates symptoms.
There are many types of hormone replacement therapies. You can take HRT orally (like birth control), apply it topically (that’s most useful if you have vaginal dryness or pain during sex), or wear a medicated patch. All these forms of HRT do the same thing: add hormones back to your body. But, as with any medication, HRT isn’t without risks. Understanding how it can affect your body will help you make an informed decision about your health, both now and in the future.
Is HRT for me?
When your sex hormones are plummeting, adding them back in via medication may ease the debilitating symptoms and improve your day-to-day function. Reintroducing estrogen to your body can also benefit your bone, brain, and heart health, says Javaid. That’s because lower estrogen levels are associated with medical issues like high cholesterol, high blood pressure, and lower bone density.
HRT side effects to be aware of
The study also showed that combined HRT can create dense breast tissue, reducing the efficacy of mammograms and leading to detection of breast cancer when it’s at a more advanced stage.
You don’t have to sift through these risk factors and what-ifs alone. HRT is something you should discuss with your doctor to determine if it’s the right way to handle your symptoms.
Well, now I’m just confused about HRT
According to a 2022 statement by the North American Menopause Society (NAMS), the benefits usually outweigh the risks for women under 60 who are within ten years of menopause and have no major risk factors.
NAMS doesn’t recommend starting HRT more than ten years from the onset of menopause, or after age 60, due to the increase in medical risks. Combination hormone therapy may slightly increase your risk of breast cancer if it is used for more than four to five years. Estrogen therapy alone may increase breast cancer risk if used for longer than seven years.
So how can you tell if HRT is a good option for you? According to Kecia Gaither, a board-certified OB-GYN at NYC Health + Hospitals, it’s worth a conversation with your own gyno if you’re struggling with vaginal dryness, hot flashes, night sweats, or mood changes before, during, or after menopause. (The same is true if you’ve had your ovaries removed, which automatically triggers menopause.)
How to talk to your doctor about HRT
But if HRT is a safe solution for you, be sure to ask your provider how long you’ll use the therapy, how quickly you should expect to notice relief, and if there are any side effects you should anticipate.
If your doc thinks the benefits aren’t worth it, don’t lose hope. There are plenty more ways to manage your (peri)menopause symptoms, including lifestyle tweaks and symptom-specific medications.
“I can’t repeat it enough, the leading cause of death for women is heart attack and stroke,” said La Follette. “We need to prioritize our risks as we age. We need to think about our real risks over time and the true risks to you as an individual.”
Your doctor, whether a general practitioner or a gynecologist, will help you determine whether you’re a candidate for hormone replacement therapy based on the severity of your symptoms and your personal risk factors. For example, says Gaither, if you have breast cancer now or have had it in the past, your doctor may not recommend HRT.
No matter how you manage your hot flashes or difficulty with sleeping, the good news is these manifestations of your changing hormones will subside as your body adjusts. Just know that when it comes to managing your symptoms, choose facts, not fear. Ask all the questions and you’ll come to the right decision for yourself.
