Hormone Replacement Therapy (HRT) – is it Right for You?

What’s in your hormone replacement therapy? (The facts about bioidentical hormones)

Hormone replacement therapy (HRT) is a group of medications containing female hormones that replace the ones the body no longer makes after menopause.  HRT is commonly used to treat menopausal symptoms including:

  • Hot flashes
  • Night sweats
  • Sleep disturbances
  • Vaginal dryness
  • Mood changes

HRT has also been shown to prevent bone loss and reduce fractures in postmenopausal women.

Along with the benefits, there are also risks associated with using hormone therapy that shouldn’t be overlooked. Including, but not limited to:

  • Cancer
  • Stroke
  • Blood Clots
  • Heart Disease

It is important to understand that not all women going through the transition of menopause need to be on hormone replacement therapy.  Additionally, there are other types of medications like anti-depressants which are shown to improve many of the symptoms accompanying menopause.

A Little History of HRT:

Prior to 2002, hormone replacement therapy was widely prescribed to treat menopausal symptoms.  It was also used to prevent some of the changes that occur after menopause like osteoporosis and heart disease.  In those days, almost everyone was taking HRT.  In 1991, the Women’s Health Initiative (WHI) was started to study HRT’s effectiveness in lowering the risk of heart disease and other medical conditions in women ages 50-79.  However, in 2002, the study was paused because of the increased risk of breast cancer, heart attacks, strokes and blood clots seen in women on hormone replacement therapy.  In turn, there was an abrupt decrease in prescriptions for HRT.

Since then, women’s health providers have been able to make better sense of this data and can have a meaningful discussion with their patients about the many benefits of HRT, as well as the risks.

Types of Hormone Replacement Therapy
There are two forms of HRT: synthetic and bioidentical:

  • Synthetic hormones are made in a lab and are chemically identical to the hormones in your body. These are regulated by the FDA.  The most common forms of synthetic hormones are made from the urine of pregnant mares.
  • Bioidentical or “natural” hormones are derived from plants. There are some bioidentical hormones approved by the FDA, and many that are not.

Please note: Compounded bioidentical hormone replacement is NOT regulated by the FDA.  This means that a patient is ultimately unaware of the purity, potency or quality of the product used.

What I have to Say About HRT

Many of my patients think that being on a bioidentical hormone replacement is safer because it is “more natural.”  I think it is important to recognize that “natural” is not always safer.  Although I support the use of bioidentical hormones, I only recommend bioidentical hormones that are regulated by the FDA to my patients.

Over the years, it has come to my attention that many women are having their hormone levels checked. Given the wide range of what’s considered “normal” when it comes to hormone levels in the blood – checking your levels is ineffective. It is also important to note that checking salivary hormone levels does not provide a representation of blood levels. Why? Simply because salivary levels depend on a patient’s diet, the time of day, and the specific estrogen being tested. Given all of this, when I prescribe HRT, I do not check hormone levels.

When I am discussing HRT with my patients, I also like to make it clear that high doses of any estrogen can lead to the risk of uterine cancer and blood clots. Despite the risks, if a patient elects HRT in levels high enough to help treat hot flashes, progesterone is needed to help combat the risk of cancer of the uterus.

In sum, when a patient requests HRT, I discuss the FDA approved options that make sense for her specific history, and then (and only then) will I prescribe the lowest dose that provides the most benefit.

-Submitted by Dr. Danielle Albushies

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