HRT: The (Current) Upshot

In 2013, I wrote about the conclusions a roundtable of international experts had reached about hormone replacement therapy. The gathering was put together by the Society for Women’s Health Research (SWHR), an extremely reputable organization. After the roundtable, the SWHR advocated putting “HT back on the table so that women can discuss with their providers the option of symptom relief and possible long-term health benefits.”

I agreed and still do. The information I’ve seen since then only reinforces my belief that, while it’s not right for everyone, it may be right for some, and for that reason it’s a conversation worth having with your healthcare provider, who can help you evaluate the risks for you.

Your doctor will look at your current health—your weight (women who are 20 pounds or more overweight when perimenopausal are twice as likely to develop breast cancer after menopause), lifestyle (e.g., exercise and diet), and any menopausal symptoms, such as hot flashes and disrupted sleep.

Your doctor will also want to discuss your family medical history, including, for example, whether any immediate family members have had Alzheimer’s disease, strokes or heart attacks, osteoporosis, or breast cancer. Those are not necessarily indicators that you shouldn’t take HRT, as we’ve discussed in recent posts:

Alzheimer’s:  As the authors of Estrogen Matters have pointed out. “...[no current treatment] significantly delays or prevents Alzheimer’s disease except estrogen, which can decrease the risk of Alzheimer’s disease by up to 50 percent.”

Heart health: The research shows that when you begin HRT when you are under the age of 60 or within 10 years of entering menopause (when you haven’t had a period for 12 consecutive months), it significantly reduces coronary artery disease and overall mortality—possibly adding as many as three or four years to your lifespan, according to some experts.

Don't dismiss HRT without getting the most current information. Decide what's best for you.

Bone health: No therapy has proven to be better at preventing osteoporosis and fractures in the spine and hips than estrogen replacement therapy. In order for it to be entirely effective, however, women have to begin taking it in menopause and continue for the rest of their lives. We need to think of osteoporosis as a chronic condition, like hypertension or diabetes.

Breast cancer: When the Women’s Health Initiative found no increased risk of breast cancer when it updated its study in 2006. Furthermore, meta-analyses, which compare data from multiple studies, show that women who began HRT three to five years after their diagnoses and remained on it for an average of three years had a 10 percent decrease in chance of recurrence.

All courses of treatment have risks and benefits. My suggestion: Don’t dismiss HRT because you’ve heard it’s bad. Get the most current information. Have a conversation with your doctor, who can help you decide what’s best for you!


Dr. Barb DePree MD
Dr. Barb DePree MD

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2 Responses

Rita
Rita

April 10, 2019

I’m 70 years old and was menopaused at 47. I was put on the birth control pill to help control hot flashes which I was having every 20 minutes. Because the pill caused high blood pressure I was put on Premarin and Provera. They caused high blood pressure so then went on Estrogel and Prometrium for about 10 years. I continued having many hot flashes during all that time but not as often and not so intense. Had them every 2 hours at night. Now I’m taking 300 mg of Prometrium every night and it works better than anything I’ve ever been on. It also makes having an orgasm very easy while for over 22 years that was almost impossible. So why do I never see anything written about the benefits of just taking 300 mg of Prometrium?

Dr Barb
Dr Barb

April 10, 2019

Rita: There is no evidence to say progesterone benefits sexual function. It does promote sleep and it can reduce anxiety, it can also reduce hot flashes. If those symptoms contribute to sexual function then maybe there is benefit. Estrogen and testosterone are both considered ‘pro-sexual’, progesterone is considered ‘neutral’ sexually. The typical dose is 100 mg at bedtime, occasionally using 200 mg at bedtime. I likely have no patients on 300 mg, some of the negative effects usually become bothersome at higher doses like fluid retention/swelling, lethargy/fatigue, irritability, GI related symptoms/constipation. But there are variations in all things, glad that you have found success!

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