Do The Benefits of Hormone Replacement Therapy Outweigh the Potential Risks? Research Says Yes

Hormone replacement therapy (HRT) has a complicated history. Once used routinely to treat menopausal symptoms (hormone therapy principally focuses on restoring the estrogen that declines as women age), large-scale landmark clinical trials in the early 2000s reported slightly increased incidences of breast cancer. This became the primary headline of these studies, sparking skepticism and fear. As a result, the use of HRT plummeted¹.

However, a new study published in the Canadian Medical Association Journal says it’s a safe treatment option and recommends HRT as a first-line therapy for menopausal women² without risk factors to improve their quality of life.

USC researcher and professor of medicine Howard Hodis believes HRT has been unfairly judged. He aims to demonstrate the benefits of HRT and runs a major National Institutes of Health-funded study to see how it “affects women’s thinking and cardiovascular health³.”

In addition to treating symptoms like hot flashes, HRT, which contains the female hormone estrogen, helps prevent bone loss and osteoporosis-related fractures⁴ or fall risk related to low bone density. Studies have also shown HRT has an impact on heart disease, the leading killer of women in Canada. According to Dr. Hodis, “Hormone replacement therapy is linked to cutting the number one cause of death by about half for the women who opted to take it.”

What’s With the Mixed Results? 

The Women’s Health Initiative clinical trial in 2002 made news when it suggested that participants who received HRT had an increased risk of breast cancer, with no benefits to their heart health. However, previous observational studies had shown that women who opted into HRT had reductions in cardiovascular disease and in total mortality.

How could all of these studies show such different results? The age of participants was a major factor. According to this article, “When physicians were performing observational studies, they were examining women between the ages of 45 to 55, the vast majority of whom had started HRT at the time of or just before the onset of menopause in order to mediate its symptoms. By contrast, the participants in the Women’s Health Initiative were on average 63 years old, nearly 12 years past the age of menopause onset.”

“If you’re 45 or older and starting to have hot flashes, night sweats or mood or sleep changes, it could be your hormones, and it might be time to start some active management,” says Nanette Santoro, chair of the department of obstetrics and gynecology at the University of Colorado Anschutz Medical Campus.”

Sooner is Better When it Comes to HRT

Age matters when it comes to HRT, and sooner is better. According to the NHS, “If you're under 60 years old, have menopause symptoms, and are not at high risk of breast cancer or blood clots, the benefits of HRT are likely to outweigh the risks.”

Who can benefit from HRT?

Hot flashes, night sweats, insomnia, depression, and muscle and joint pain are just a few of the symptoms women in their mid to late 40’s and older experience as part of the menopause transition.

If you’re 45 or older and starting to have hot flashes, night sweats or mood or sleep changes, it could be your hormones, and it might be time to start some active management⁵,” says Nanette Santoro, chair of the department of obstetrics and gynecology at the University of Colorado Anschutz Medical Campus.

With 3 out of 4 women experiencing menopausal symptoms that interfere with their daily lives, according to the Menopause Foundation of Canada, HRT is an important option for women to consider. If you think HRT might be right for you, it’s important to speak with your healthcare provider about your symptoms, medical history, and potential risk factors, and what approach will be best for your individual needs. HRT is not a one-size-fits-all solution, and the smart use of HRT means taking an individualized approach (the best product and delivery method for you) with regular monitoring and possible lifestyle changes to physical activity, nutrition, and stress management.

Evan Carey, Health researcher

REFERENCES

¹https://www.medicalnewstoday.com/articles/managing-menopause-hormone-therapy-is-back#Conflicting-information-on-hormone-replacement-therapy

²https://www.cmaj.ca/content/195/19/E677

³https://today.usc.edu/benefits-hormone-replacement-therapy-women-estrogen-usc/

⁴https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520366/#:~:text=Thus%2C%20standard%20HRT%20is%20effective,for%20a%20high%20fracture%20risk.

⁵https://www.washingtonpost.com/health/hormone-therapy-long-shunned-for-a-possible-breast-cancer-link-is-now-seen-as-safe-and-helpful-as-a-short-term-treatment-for-most-women-in-the-throes-of-menopause/2020/02/28/1fd19f66-54cd-11ea-929a-64efa7482a77_story.html

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