When to consider Hormone Replacement Therapy.
The answer to this question is simple but complicated. You can take Hormone Replacement Therapy (HRT) if you are having symptoms of menopause and or symptoms of perimenopause. Menopause and perimenopause affect women differently but can start as early as age 35. Women experience numerous symptoms including:
Longer cycles. Shorter cycles, heavier cycles, lighter cycles, No periods, Itchy skin, Sleep disturbances, anxiety, depression, heart palpitations, Dry skin, vaginal dryness, cognitive changes, Night sweats, Hot flashes, Irritability, Headaches, achy joints, and more…
So, deciding to start HRT is a personal decision but we want to be educated when making these decisions. What are the risks associated with Hormone replacement therapy? I would like to be clear about this fact that yes, there are risks associated with HRT. There are risks associated with anything and everything we put in our body. Nothing is without risk. This is why it is important to go over the risk/benefits when starting therapy. Do the benefits outweigh the risks or not and that is a question only you can answer after being properly educated.
This is what we know.
When women use estrogen and progesterone combined therapies as compared to women using placebo (cases per 1000 women for five years of HRT) you see this:
•Coronary heart disease (CHD) – 2.5 additional cases
•Invasive breast cancer – 3 additional cases
•Stroke – 2.5 additional cases
•Pulmonary embolism – 3 additional cases
•Colorectal cancer – 0.5 fewer cases
•Endometrial cancer – No difference
•Hip fracture – 1.5 fewer cases
•All-cause mortality – 5 fewer events
Women using estrogen therapy alone (This is only an option for women who no longer have a uterus):
•CHD – 5.5 fewer cases
•Invasive breast cancer – 2.5 fewer cases
•Stroke – 0.5 fewer cases
•Pulmonary embolism – 1.5 additional cases
•Colorectal cancer – 0.5 fewer cases
•Hip fracture – 1.5 additional cases (of note, there was an overall decrease in all osteoporotic fractures in both the estrogen and combined estrogen-progestin groups)
•All-cause mortality – 5.5 fewer events
Did you notice that both show fewer deaths when HRT therapy is use?
In 2002 the Women’s health Initiative (WHI) study on HRT was one of the largest women’s health research projects ever launched in the United States. The WHI study began in 1991 and lasted until 2005.This study changed the map on the use of hormone therapy for the next two decades. This study showed that HRT increased the risk of heart attacks, strokes, and cancer. HOWEVER, this study was found to have some major flaws.
1. The type of hormone used: Prempro a combined synthetic estrogen and progestin daily pill and Premarin a conjugated equine estrogen from pregnant horse urine.
2. The average age were older women (mean was 62.7) this alone putting them at increased risk for cardiovascular risk because of their age not necessarily because of the use of HRT
Most providers have learned from this study and do use different HRT options, but even if you are using prempro you will find that your risk is still small but present
For every 10,000 women taking Prempro, each year:
• 8 more will develop breast cancer
• 8 more will have blood clots in the lungs
• 8 more will have a stroke
• 7 more will have a heart attack or other coronary event
Again, this study only looked at the use of Prempro (combination of estrogen and progesterone) and Premarin (estrogen alone) and we know that the risks are not as high when we avoid the oral forms. Using an estrogen patch, pellet or estrogen cream reduces the risk of clotting because these forms of estrogen avoid what we call fist pass, so the dosing does not have to be as high.
It is important to keep in mind that there are major differences between the different forms of HRT. For example, patch, creams, pellets, troches doesn’t appear to increase your risk of gallbladder disease as oral estrogen does and It also does not raise Triglyceride levels like oral estrogen does and it does not increase your risk of clots.
It is not estrogen and progesterone alone that puts women at risk BUT the TYPE used.
Most providers do agree on starting HRT within the first 10 years of menopause or sooner. If it has been 10 years since your last menstrual period, there is an increased risk of cardiovascular risk when using HRT.
There's no fixed time on how long you can take HRT. This really is an individual decision BUT be aware that insurance companies do not see it that way. They feel that after the age of 65/66 you no longer need HRT and will likely stop paying for it, so plan on paying out of pocket for therapy.
There can be many benefits to taking HRT as you enter this phase of your life. Not only does it help with the symptoms you are having but it can also help with your collagen production (we lose about 40% with the loss of estrogen when we go through menopause, it also helps to maintain healthy hair, strong bones, mental clarity, muscle strength, good sleep. All of which help us to live a healthy vibrant active life.
Do your research. Ask the questions. Find a provider that will listen to you and your concerns and help determine the best option for you.
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