HRT: Do the benefits outweigh the risks?
It’s been a few months since I started my journey into what I think is perimenopause. The symptoms have been subtle which is why I only suspect perimenopause. It began with anxiety that I had never experienced before that has since subsided since I started low-dose Sertraline.
I’ve had many people ask me why I haven’t started Hormone Replacement Therapy (HRT) yet and it comes down to my need to be presented with all the evidence that the benefits would exceed the risks. Like many healthcare professionals, I have a knowledge deficit because menopause is just not something we learn in our medical training. Hopefully that will change, but in the meantime I’m left to my own search for information.
Aside from the anxiety, one of the other emerging symptoms has been heartburn and brain fog. I always thought that estrogen was only responsible for our reproductive health, but I recently learned that estrogen receptors are found throughout much of our body. In fact, estrogen plays a role in our breast tissue, brain, our skin, hair, heart, vascular system and gastrointestinal system. So it’s no shock that I’m noticing changes in my cognition and digestion.
Essentially, menopause is the gradual failure of our ovaries. Just like our heart and lungs can fail with age, so does our reproductive system. The symptoms we experience are due to diminishing levels of estrogen. One could assume then, that replacing it would alleviate these symptoms and that is exactly how hormone therapy came into the medical scene. But, it’s been a rocky road.
The first oral treatments for menopause were harvested from the ovarian tissues of animals and given as a treatment for menopausal symptoms. As science evolved, estrogen was manufactured as Emmenin in 1933 and then Premarin in 1942. The demand for these drugs climbed and by 1975, estrogen was on the top 5 most prescribed medications in the United States. This increase in prescriptions meant that we also needed studies to evaluate the safety and efficacy of these drugs. In 1975, the New England Journal of Medicine published a study that demonstrated an increased risk of endometrial cancer in women who were taking estrogen. This led to a temporary fear in HRT and decrease in its use until 1992. New information emerged that demonstrated endometrial protection when the hormone, progesterone, was added to estrogen. Women were granted relief once again until 1998.
The largest randomized controlled trial by the the Women’s Health Initiative was launched so that a gold standard in HRT could be set. Unfortunately, there was a gross interpretation of the data by the media…..sound familiar?
The media reported that HRT led to an increased risk of breast cancer and stroke. What they didn’t say was that the risk was an insignificant increase of less than 1%. Women were once again impacted as their physicians stopped prescribing HRT. I only recently learned that the risk of stroke no longer existed because of my own deep dive into the topic! I imagine that there are other healthcare providers that lack this update because it wasn’t until 2022 that the Menopause Society clarified risk in HRT. In addition, there just hasn’t been any ongoing education in this area of women’s health.
I have my annual gynecology appointment coming up and now that I’ve been researching this topic, my apprehension of HRT has greatly diminished. We now know that estrogen reduces the risk of osteoporosis, coronary artery disease, metabolic syndromes and dementia. We also know that the risk of endometrial cancer in HRT is offset by adding progesterone to the mix. The reality is that in my particular situation, I have no family or personal history of endometrial cancer, thromboembolic disease or breast cancer so the benefits appear to outweigh the risks of HRT. I’ll keep you updated on the outcome of my visit!
❤️ Tara