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Woman in menopause who uses hormone replacement therapy

5 Top Facts About Hormone Replacement Therapy

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There are a lot of questions, fears and misinformation around treating menopause symptoms with hormone therapy. We’ve got answers.

Want to put an end to hot flashes, night sweats and mood swings? Read on to find out if hormone therapy could help you find relief from those pesky menopause symptoms.

What is hormone therapy?

After your period stops for an entire year, you officially enter menopause (typically around age 46-56 for most women). During this time and for many years before, your ovaries stop producing eggs and your hormone levels, estrogen, and progesterone fall, causing uncomfortable symptoms including vaginal dryness, irritability, moodiness, trouble sleeping and those dreaded hot flashes.

In some cases, plummeting hormones can contribute to bone loss/osteoporosis, insulin resistance, decreased muscle mass and even increase the risk of heart disease from the lack of our female hormones. Hormone therapy replaces the natural estrogen and progesterone your body has made all your life, but now is suddenly missing. Replacing these identical hormones can alleviate the 35 identified related symptoms of menopause.

What are the risks?

The Women’s Health Initiative trial, a study done over 20 years ago, found that hormone therapy might increase risk of breast cancer, heart disease, stroke and blood clots. The media jumped this information, panic and fear soon spread and menopausal women across the country abruptly stopped their hormones. Doctors stopped prescribing and recommending hormones to their patients in all the confusion. But we now know that the results of this one study and the risks associate with hormones were overblown. Follow-up research has indicated that the type of hormone therapy (not all hormones are the same) and how it’s taken can make a difference and produce different results.

To be clear and factual: Hormone replacement therapy is unquestionably the single most effective treatment for easing all the symptoms (yes, there are over 30 symptoms of menopause) and improving quality of life.

The debatable question is do hormones increase the risk of breast cancer, heart disease and stroke? Most women fear breast cancer, but the number one killer of women today is heart disease. Data is now showing that if HRT is started early, for most women, hormones can help protect your heart.

In the above-mentioned WHI trial, the women on Prempro, a specific brand of estrogen and synthetic progesterone used in this study had a slight increased risk of breast cancer (1 more breast cancer per 1,000 women) but it was not statistically significant. Interestingly, the Premarin (estrogen only group) had a 20% decreased risk of breast cancer compared to placebo which was statistically significant. The WHI trial found no increased risk of breast cancer in the group of women using estrogen alone. As you can see, the data is conflicting, confusing and lends suggestion that Provera, the synthetic progesterone, may play more a role in breast cancer risk than the estrogen component, but again this data is limited as the WHI trial was abruptly ended.

In a 2004 follow-up analysis of the data, women who started hormones before the age of 60 or the first 10 years of menopause, had a reduced risk of dying from ALL causes compared to placebo.

Are there side effects?

When starting hormones, side effects such as breast tenderness and headaches are rare and usually resolve within the first few months. Hormone therapy can also result in some vaginal spotting, and this might be a bit heavier for some women. While this can be a side effect of starting on hormone therapy, it’s important to tell your doctor about any postmenopausal bleeding as other things such as uterine hyperplasia and cancer can cause bleeding and needs evaluation.

What are the benefits?

Hormone therapy is the most effective way to treat the symptoms of menopause. It can offer relief from hot flashes and night sweats, improve uncomfortable vaginal dryness, sleep issues, anxiety/depression, painful intercourse, joint and back pain and prevent the bone loss that often occurs in early menopause. If HRT is started in early menopause, studies suggest that HRT is protective and can decrease your risk of heart disease, bone fractures, diabetes, dementia, and colon cancer.

How do I know if it’s right for me?

It’s important to consider whether the benefits outweigh the risks, so talk to your doctor about your symptoms and discuss your health history to decide what’s best for you. In the past, hormone therapy was recommended to be used at the lowest possible dose for the shortest amount of time, but the tides are turning and now if started early within the first 10 years on menopause, research suggests that hormones are beneficial and safe for most women and can be continued reevaluating annually with your doctor.

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