Revisiting hormone replacement therapy

In the heyday of hormones, just about every woman who came into her primary care provider’s office with symptoms of menopause left with a prescription for hormones. At first blush, hormone replacement therapy seemed like a gift to women who had hit the hot-flash years.

The idea was simple: Replace the hormones (specifically estrogen and progesterone) that your body stops making as it goes through menopause and say goodbye to symptoms like irregular periods, weight gain, and those blasted hot flashes.

It worked. Women rejoiced. That is, until 2002 ⎯ when the Women’s Health Initiative released a study showing that women who received hormone replacement therapy (HRT) traded in menopause symptoms for an increased risk of heart attack, breast cancer, and stroke. Pulmonary embolism and even dementia seemed to be offshoots of early HRT. The stuff wasn’t at all redeemed by its apparent benefits: protection against colon cancer and osteoporosis.

Use of HRT dropped, and women went back to fanning themselves. But the study left a little to be desired. For one thing, many women who participated had pre-existing conditions. And the average age of women in the study was 63. In fact, women who had symptoms but weren’t over the age of 50 were excluded.

Women have nonetheless thrown their hormone pills out the window, and HRT strikes worry ⎯ if not outright fear ⎯ in the hearts of menopausal women everywhere.

There’s good reason to reconsider.

Research has refined these medications, and the lower-dose pills that are now available seem not to cause the daunting side effects that the WHI study identified. And we now know that starting treatment in the early part of menopause reduces your risk of experiencing side effects.

Transdermal estrogen is getting a lot of attention as an effective and safer option. Because the low dose of hormones is absorbed by your skin, it bypasses your liver. It appears not to increase your risk of stroke like oral estrogen does.

Although I certainly recommend that your primary care provider assess your risk for heart disease and breast cancer before you consider HRT, I also think that the tides have turned. We now see reduced risks and increased benefits from HRT ⎯ especially if you start early in menopause.

HRT is not risk-free. It’s just not the boogey-man that it seemed to be early on. Check it out for yourself, and talk with your primary care provider to find out about the newest options. You can also send questions to me directly or call 317-338-4HER to find out more.

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