By Carolyn Moyers, D.O., FACOG
There has been controversy around hormone replacement therapy (HRT) over past decades. HRT has gone from a standard treatment for hot flashes and other symptoms of menopause to a decision each woman must weigh carefully based on her body and health history.
Some research has linked HRT to increased risk of heart disease, stroke, blood clots, and breast cancer, while other studies have shown hormone replacement may lower the risk of osteoporosis and improve other aspects of health.
Read the literature on this and your head will be spinning. Recent studies are showing benefits to women, particularly women who use HRT close to the onset of menopause, although, the duration of therapy and relationship to heart health awaits further study.
Hormone replacement therapy – estrogen, estrogen + progesterone, and dare you add testosterone – It’s all so confusing. “What are my risks?” patient’s often ask.
Risks in perspective
- The risk of heart disease to an individual woman taking hormone therapy is very low.
- Your individual risk of developing heart disease depends on many factors, including family medical history, personal medical history and lifestyle practices.
- If you stopped having periods or lost normal function of your ovaries before age 40, you have a different set of heart and blood vessel (cardiovascular) health risks compared with women who reach menopause near the average age of about 50. This includes a higher risk of coronary heart disease.
Talk to your provider about your personal risks. If you’re at low risk of heart disease, and your menopausal symptoms are significant, hormone therapy is a reasonable consideration.
HRT risks may vary depending on:
- Whether estrogen is given alone or with a progesterone
- Your current age and age at menopause
- The dose, type of estrogen and how you take it (oral, transdermal, transvaginal)
- Other health risks, such as your family medical history and cancer risks
Who should NOT take hormone therapy?
If you’ve already had a heart attack, HRT is not for you. If you already have heart disease or you have a history of blood clots, the risks of hormone therapy have been clearly shown to outweigh any potential benefits.
Menopause symptoms: What are they and why are women seeking treatment?
As women age, they find themselves with sudden sensation of extreme heat in the upper body, face, neck and chest, referred to as a hot flush. The unwelcome sweating, flushing, chills, clamminess, anxiety and even heart palpitations accompany this. These unwelcome vasomotor symptoms vary in how often and how long they last. Patients report symptoms lasting anywhere from 4-10 years around menopause. While menopause is defined as not having cycles for 12 months, symptoms do not end with the end of menstrual cycles. Sigh . . . The low estrogen levels leads to changes in the vagina– vaginal or vulvar dryness, discharge, itching and painful intercourse. The lack of estrogen leads to a loss of superficial epithelial cells, vaginal folds and elasticity and narrowing and shortening of the vagina. In addition, the pH of the vagina even changes and can lend to more urogenital infections. “Really?!” I hear you asking yourself. All these changes have women feeling frustrated, fatigued and often questioning their sanity.
HRT and the Heart
The consensus at this time is that menopausal hormone replacement therapy should not be used for the primary prevention of coronary heart disease. There is some data that supports a “timing hypothesis” – meaning, the cardiovascular benefit is most profound when HRT is used at the onset of menopause versus someone who has been menopausal 10 years or more. We do not know the affects of the duration of HRT at this time.
Your provider will likely recommend a heart healthy lifestyle to reduce your cardiovascular risks.
- Don’t smoke or use tobacco products.
- Get regular physical activity.
- Eat a healthy diet focusing on fruits, vegetables, whole grains and low-fat protein.
- Maintain a healthy weight.
- Get regular health screenings to check your blood pressure and cholesterol levels to detect early signs of heart disease.
We also understand that quality of life must be considered when prescribing HRT. Lifestyle changes and over the counter solutions don’t always provide the relief you so desperately desire. HRT must be individualized based on each woman’s risk-benefit ratio and clinical presentation.
How is HRT different at HerKare?
A customized treatment plan specific to each patient is designed to improve symptoms. The goal is to achieve a balance of hormones, vitamin deficiencies, and thyroid function.
A balancing act
Among U.S. women, nearly 1 in 4 deaths each year is due to heart and blood vessel (cardiovascular) disease. Women of all ages should take heart disease seriously.
Most healthy women can safely take HRT for menopausal symptoms without significantly increasing the risk of heart disease. If you experience classic menopausal symptoms talk to your provider about how you can relieve troublesome symptoms without putting your health at risk.