Menopause Hormone Replacement Therapy

First approved by the FDA in the 1940s and widely prescribed by the 1960s, menopause hormone therapy (MHT) was once considered the most effective treatment to relieve menopause symptoms, improve quality of life, and prevent more serious conditions from occurring after menopause. However, when a flawed 2002 study claimed that MHT could increase the risk of blood clots, stroke, and breast cancer, many doctors stopped recommending it, and a lot of women stopped using it.

This article explains why the 2002 Women's Health Initiative (WHI) study was flawed and how a re-evaluation of the study 20 years later is putting women's minds at ease about choosing MHT.

We also outline why estrogen supplementation is central to long-term female health, why MHT types and doses should be prescribed on an individual basis rather than a one-size-fits all, and what you can do to find the best form of MHT for you.

Is Menopause Hormone Therapy (MHT) the Same as Hormone Replacement Therapy (HRT)?

Yes, MHT and HRT are essentially the same however, the term MHT is now used to differentiate menopause hormone therapy from other types of hormone replacement therapy.

What Causes Menopause Symptoms?

The sex hormones estrogen, progesterone, and testosterone work together throughout a woman's life to support puberty, menstruation, reproduction, pregnancy, and even breastfeeding. As midlife approaches, however, and the reproductive stage comes to an end, the female body naturally decreases sex hormone production. This typically occurs between ages 45-52 but can be earlier or later for some.

That said, the sex hormone levels don't lower steadily. Instead, they fluctuate, creating estrogen-progesterone hormone imbalances and then stabilize somewhat before dropping again.

This is why menstruation becomes irregular during perimenopause and eventually stops once menopause is reached and hormone levels permanently stabilize. However, the sex hormones support other body systems too, which also feel the impact of decreasing sex hormone production.

Estrogen

Estrogen, for instance, runs through almost every tissue in the body to support the skin, bones & muscles, brain function, cardiovascular support, metabolism, and vaginal health, in addition to the reproductive system.

During the menopause transition, lowering estrogen levels can cause symptoms like irregular menstruation, brain fog, anxiety, depression, abdominal weight gain, and cardiovascular disease. Bone remineralization and muscles are also affected by low estrogen levels, leading to a loss of muscle mass and the possible onset of osteoporosis later in life for some women.

Progesterone

In addition to supporting the uterine lining, progesterone helps to promote emotional well-being, sleep, and bone strength. Throughout the menopause transition, low progesterone or estrogen-progesterone imbalances can contribute to mood swings, fatigue, and poor sleep patterns.

Testosterone

Testosterone helps to regulate female libido and energy levels, both of which can drop when testosterone levels lower. Although its production typically starts falling in the early 30s for women, it continues to drop during perimenopause.

Why is MHT Recommended?

MHT involves supplementing estrogen, progesterone, and sometimes testosterone to rebalance fluctuating hormones during perimenopause, alleviate symptoms, improve quality of life, and prevent more serious conditions like osteoporosis or cardiovascular disease from occurring postmenopause.

Symptoms relieved by MHT include anxiety, brain fog, depression, hot flashes, loss of muscle mass and bone density, poor sleep, mood alterations, low libido, vaginal dryness, discomfort during sex, and more.

Although all sex hormones play a role in the menopause transition, estrogen is the main star of the show for overall female health and wellness. It is the dominant ingredient in most MHT treatments, but estrogen can be prescribed in several doses, using various administration methods, to suit each woman's needs.

Why Estrogen Matters

According to the book Estrogen Matters, by Avrum Bluming, MD and Carol Tavris, PhD, the benefits of estrogen supplementation during menopause were well established before the 2002 WHI study. Now backed by over 80 years of evidence, estrogen supplementation during the menopause transition is widely recognised for its efficacy in alleviating several menopause symptoms.

These include hot flashes, vaginal dryness, abdominal weight gain, discomfort during sex, brain fog, and fluctuating moods. Estrogen supplementation during perimenopause has also been found to reduce heart disease and bone fractures (a sign of osteoporosis) in menopausal women by as much as 50%.

How Was the 2002 Women's Health Initiative Study Flawed?

The findings of the 2002 WHI study suggested that all women taking MHT had an increased risk of breast cancer, blood clots, and stroke, irrespective of their age or previous health issues. Scientists and medical experts who have since reviewed the study found the risks linked to MHT in this study were miniscule, poorly explained, and did not apply to all women.

Essentially, the study was flawed due to the age of participants, the type and dose of hormones used, and the oversimplified clarification of risks over benefits for all women.

Age of Participants: The average age of women who participated in the 2002 WHI study was 63, meaning they had already transitioned through perimenopause and reached menopause. Given that MHT has different effects for women starting perimenopause than those who are already postmenopausal, it was unfair and incorrect to apply their findings to all women.

Type of Hormones Used: The WHI study primarily used somewhat higher-than-usual doses and a combination of conjugated equine estrogens (CEE) derived from horse urine with medroxyprogesterone acetate (MPA), a synthetic form of progesterone.

The participants' age, medical histories, manner in which the hormones were administered, and the combination of synthetic hormones are believed to have contributed to the increased risks of breast cancer and heart disease associated with the study findings. It's also worth noting that only one type of MHT was used, whereas various types of MHT, including bioidentical or natural hormones and administration methods, exist today.

Risk/Benefit Ratio: The study focused on the risks of MHT based on one type of hormone therapy in older women. However, the study did not adequately account for the potential benefits of any other type of HRT in women of various ages to reduce the risk of osteoporosis, fractures, and heart disease.

What the Research Says About The 2002 WHI Study - 20 Years Later

Ongoing research into MHT and the 2002 WHI study revealed that the benefits of hormone therapy during menopause far outweigh the risks when prescribed as a personalized treatment on a patient-to-patient basis. Instead, vital criteria should also be taken into account before prescribing MHT, including a woman's age, individual health profile, whether they had breast cancer or a hysterectomy, and menopausal status.

Why Age Matters with MHT

The WHI study was largely based on women aged 60 and over. Whereas, ongoing trials have revealed that the risks of MHT for healthy women younger than 60 or within 10 years from reaching menopause are extremely low.

Research has also determined that MHT can be safely continued in postmenopausal women with no history of breast cancer. In these cases, health providers are advised to monitor MHT doses and adjust them as patients age.

Re-evaluating the Risks of Breast Cancer with MHT

Contrary to media reports, the risk of developing breast cancer from taking MHT is significantly lower than that associated with drinking alcohol, smoking, or being overweight.

Estrogen-only MHT carries no risk of developing breast cancer, however, it is only recommended for women who have had a hysterectomy. This is because progestin/progesterone is needed to eliminate the risk of hyperplasia and endometrial cancer for those who have a uterus.

Women with a uterus are typically prescribed Combined MHT, which contains estrogen and synthetic progestin or bioidentical (natural) progesterone. Synthetic progestin is linked to a slight increase in the risk of developing breast cancer, but combined MHT containing estrogen and micronized bioidentical progesterone poses no increased risk of breast cancer.

Both synthetic progestin and bioidentical progesterone are still prescribed as part of combined MHT, so it's worth asking a healthcare provider about using one over the other.

The Risk of Clotting Does Not Apply to All

Continued research into the WHI study revealed that an increased risk of clotting only applies to women with established risk factors who take estrogen orally instead of transdermally (through the skin). Further evaluation also showed that MHT can be adapted to treat women with a history of blood clotting.

Since the WHI study, subsequent analyses have found that the risk of stroke in women is not significantly increased with MHT, but with age and underlying conditions. During midlife, women have a lower incidence of stroke than men, however, the risk is known to double in the decade after menopause.

Factors that can increase the risk of stroke are age, heart conditions, high blood pressure, diabetes, obesity, and smoking. In hindsight, this makes sense given that the WHI study focused on women aged 60 and over who already posed an increased risk of stroke due to their postmenopausal age and possible underlying conditions due to low estrogen levels.

Further studies also suggest that instead of increasing the risk of clotting in younger menopausal women, MHT can prevent clotting due to low estrogen's effect on the heart. Essentially, the risk of clotting depends on each woman's lifestyle and underlying health.

The Different Types of MHT

Modern menopause hormone therapy typically contains estrogen, estrogen and progestin/progesterone, or testosterone, and each is now available as synthetic or bioidentical hormones. Administration methods also now vary to accommodate each individual's needs. For example, MHT can be administered as a cream, gel, pills, patch, ring, spray, or IUD.

Why one is prescribed above another usually depends on each woman's age, symptoms, medical history, their uterus status, and which part of the menopause journey they have reached.

Local or Systemic MHT

MHT is also categorized as local hormone therapy or systemic hormone therapy. Local hormone therapy is prescribed to treat symptoms in one part of the body. Systemic hormone therapy is absorbed throughout the body to treat more than one menopause symptom.

Estrogen creams, vaginal rings, and vaginal suppositories are forms of local MHT, for instance, and are prescribed to ease genitourinary symptoms of menopause like urinary issues, vaginal dryness, vulvar irritation, and pain during sex.

Systemic MHT, which contains estrogen, estrogen with progestin/progesterone, or testosterone, is typically administered as pills, skin patches, gels, or sprays.

How to Know Which Type of MHT is Right for You?

MHT is not a one-size-fits-all type of treatment, so it's always best to seek medical advice to determine which type is best for your symptoms, stage of menopause, and overall health. However, with very little training on the subject of menopause and hormone therapy, most general practitioners do not have the expertise necessary to decipher why a woman might need one type of MHT over another.

For this reason, Intimate Rose provides online menopause relief through telehealth. By answering a confidential and free assessment on your symptoms, age, and medical history, the menopause experts at Intimate Rose will provide MHT suggestions tailored to your unique needs.

Their menopause experts may schedule a one-on-one online consultation for more info if needed, and once compiled, your treatment plan can be discreetly delivered to your door within a few days. Follow-up consultations are also available to monitor symptom relief, dose alterations, or unexpected side effects.

As a leader in female health solutions, pelvic care, menopause, and postnatal recovery, the experts at Intimate Rose have also developed non-hormonal pelvic tools for easing menopause symptoms like a weak pelvic floor or urine leaks (Kegel Weights), vaginal dryness, or discomfort during sex (vaginal dilators and personal lubricants that won't upset the vaginal pH).

Intimate Rose is also one of the few female health companies to hold FDA approval on their pelvic tools, with each made from the softest and safest medical-grade silicone that feels comfortable in the vagina. Despite offering quality products, Intimate Rose provides value for money like no other competitor in the field.

Conclusion

MHT is considered a safe and effective method of easing menopause symptoms, improving quality of life, and preventing the onset of other conditions postmenopause. Despite ongoing research, however, an incorrectly presented study and the exaggerated media coverage that followed has caused many women to deny themselves a more comfortable menopause journey with MHT.

Above is an overview of the flawed 2002 WHI study, which incorrectly suggested MHT posed risks for all women, and the updated research that has since debunked these findings.

If you're in your 40s or 50s or you're experiencing menopause symptoms like hot flashes, vaginal dryness, or poor sleep a little earlier than expected, MHT could be the answer you're seeking. Due to GPs' lack of education on the various types and doses of MHT, female health experts, Intimate Rose, are offering a free menopause symptom assessment, plus discreet treatment plan deliveries and ongoing menopause support.

References

Jama Network - The Women's Health Initiative Randomized Trials and Clinical Practice - https://jamanetwork.com/journals/jama/article-abstract/2818206

National Library of Medicine - Trial overstated HRT risk for younger women - https://pmc.ncbi.nlm.nih.gov/articles/PMC5415400/

Climacteric - The evidence base for HRT: what can we believe? - https://www.tandfonline.com/doi/abs/10.1080/13697137.2017.1280251?journalCode=icmt20

National Library of Medicine - Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy: Current Concepts - https://pmc.ncbi.nlm.nih.gov/articles/PMC8034540/

Breast Cancer Research Foundation - What Research Says About HRT and Breast Cancer Risk - https://www.bcrf.org/about-breast-cancer/hrt-breast-cancer-risk/

National Library of Medicine - Menopause and Stroke: An Epidemiologic Review -

https://pmc.ncbi.nlm.nih.gov/articles/PMC3615462/