For decades, hormone replacement therapy has been used to routinely treat menopausal symptoms and was even once believed to protect women’s health as they aged. But questions have been raised regarding the safety and efficacy of hormone replacement.

So how do you know if hormone replacement is right for you, and most of all, is it safe?

Hormone replacement therapy (HRT) is a medication that contains female hormones, estrogen and progesterone, that the body no longer makes or makes an insufficient amount after menopause, the surgical removal of ovaries, or some types of cancer treatment. Some HRT medications will also include testosterone and DHEA supplementation based on certain symptoms.

Women may experience significant changes or symptoms as they go through menopause, usually in their late 40s to early 50s. These symptoms can include:

  • Hot flashes
  • Night sweats
  • Racing or irregular heartbeat
  • Headaches
  • Joint pain
  • Leg cramps and restless leg
  • Vaginal dryness
  • Painful intercourse
  • Changes in skin texture
  • Changes in mood
  • Insomnia

Emily Emmet, M.D., an OB/GYN and physician on the medical staff at Texas Health Fort Worth, says that while every woman will go through menopause at some point in her life, some may not require HRT to help relieve symptoms.

“Menopause is different for every woman and the severity of symptoms will vary for each woman. Many women find that they only have very minimal symptoms that are tolerable and not interfering with their quality of life. These women do not necessarily need to start hormone replacement,” she explains. “Other women will have severe symptoms that interfere with their lives on a daily basis. This could be constant hot flashes during the day, severe night sweats which interfere with their sleep, or severe vaginal dryness causing painful intercourse. When symptoms are severe and are interfering with a woman’s quality of life, hormone replacement can be a very good treatment option.”

The North American Menopause Society states that most healthy, recently menopausal women can use HRT for relief of their symptoms but there are a few exceptions. Women who have a history of stroke, breast cancer or uterine cancer, severe migraines, heart disease, or blood clots should not take hormone replacement and should speak to their doctor about alternative treatment options.

In addition to reducing symptoms of menopause, HRT was widely used to help prevent osteoporosis and cardiovascular disease, but in 2002, the Women’s Health Initiative (WHI) study was published, sparking a lot of controversy. The 10-year study focused on strategies for preventing heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Women aged 50 to 79 were placed in random test groups: hormone therapy, dietary modification, calcium and vitamin D supplementation, or observation (placebo). After the study was published, experts came to the conclusion that HRT may actually increase the risk of cancer and stroke, but Emmet says HRT and understanding its effects has come a long way since that study was published.

“The WHI study showed that combination (estrogen and progesterone) hormone therapy slightly increased a woman’s risk of stroke and breast cancer. Women who were only taking estrogen had an increased risk of stroke, but no increased risk of breast cancer,” she explains. “This study was looking at older women who were already in menopause, and it is hard to generalize these findings to younger women who are recently menopausal. Research is ongoing to see if hormone replacement is safer if started at a younger age, when a woman is first going through menopause. Because of these risks, it is important that each woman be counseled by her doctor prior to starting hormone replacement.”

Emmet adds that HRT is still proven to be effective at preventing osteoporosis and decreasing the risk of osteoporotic fractures, a major advancement considering that half of women over the age of 50 will experience a bone fracture related to osteoporosis, but the jury is still out on its effects on cardiovascular health.   

The decision to start — or stop — menopausal treatment is highly personal. Working with your doctor can help you understand your personal risks and benefits, and will also help your doctor create an appropriate dosage and/or combination of hormones based on your symptoms.

“The goal of treatment is to be on the lowest dose of medication that can adequately treat symptoms,” Emmet says. “There are many different treatment options available for hormone replacement. If a woman has not had a hysterectomy, she needs to be on a combination of both estrogen and progesterone. This can be taken as a combination oral pill or a patch.

“Most women will find significant improvement in their symptoms within one to two weeks, and common side effects can include vaginal bleeding (usually only when the medication is first started), breast tenderness, and headaches.”

If you decide to start HRT, you may wonder if you can stop or if this is something you will have to continue doing for the rest of your life. Many women find that symptoms recur after stopping HRT, regardless of age or how long she has taken the medication. Because of this, Emmet says there is no explicit recommendation for stopping HRT by a certain age, but using the therapy for up to five years is typical.

Any woman who is considering HRT should talk to a doctor who can go over her medical history and discuss her own personal benefits or risks.

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