In order to address menopausal symptoms including hot flashes, vaginal dryness, and mood swings, hormone replacement therapy (HRT) includes increasing a woman's estrogen and progesterone levels. HRT has, however, generated debate in recent years due to studies that contend that it may raise women's risks for cancer and heart disease. In this post, we'll look at the myths surrounding HRT and the poor research that helped create them.

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HRT and Menopause

If a woman lives long enough, she will go through menopause. As the US population ages, women will spend more time after menopause than they did in the past. Postmenopausal women should decide for themselves if they want to start menopause hormone therapy. Along with the woman's quality of life, a thorough evaluation of the patient's risk of heart disease, blood clots, cancer, and broken bones should be done. Hormone therapy helps with vasomotor symptoms, the skeleton, and the genitourinary system, and it does this no matter how long it has been since menopause. When hormone therapy is stopped, these benefits go away. 

The North American Menopause Society (NAMS) says that about 6000 women in the US go through menopause every day. It is thought that more than 50 million women have gone through menopause by 2020. As the US population ages, women will spend more time after menopause than they did in the past. Postmenopausal women are more likely to have bothersome vasomotor symptoms, as well as genitourinary and sexual problems, cognitive decline, heart disease, and a lot of bone loss.  Hormone therapy has been shown over and over again to be the best way to treat bothersome vasomotor symptoms like hot flushes of menopause. It also reduces the risk of bone loss after menopause by a large amount. 

The WHI Study: The Start of HRT Misconceptions

Despite its widespread use, HRT has been the subject of controversy and misconceptions. In the early 2000s, the Women's Health Initiative Memory Study (WHIMS) found that HRT increased the risk of breast cancer, stroke, and heart disease in postmenopausal women. This study led to a decrease in the use of HRT, and many women stopped taking the treatment altogether. However, subsequent research has shown that the risks associated with HRT are relatively small and that HRT can still be a safe and effective treatment for menopausal symptoms.

But since the Women's Health Initiative (WHI) trials, there have been a lot of questions about how safe hormone therapy is. The WHI trials were done to find out what the risks and benefits of hormone therapy were for postmenopausal women, whose average age was 63, who were taking it to prevent chronic diseases.  Women were given either 0.625 mg of conjugated equine estrogen plus 2.5 mg of medroxyprogesterone acetate (MPA) if they had a uterus or just 0.625 mg of conjugated equine estrogen if they had a hysterectomy. After 5.6 years, the conjugated equine estrogen plus MPA arm was stopped because it increased the risk of breast cancer. After 7.2 years, the conjugated equine estrogen only arm was stopped because it increased the risk of stroke.  Because each arm of the WHI trials looked at a single dose and form of hormone therapy based on horse-derived estrogen and a synthetic progestin that was taken by mouth, the results cannot be used for other HRT regimens taken by  bioidentical hormone gels or creams applied to the skin. Since the WHI trials were published, experts have looked into how the way hormone therapy is made, when it is given, how it is given, and what hormones are used together affect a woman's risk. Experts now know more because of new data, so they can make personalized hormone therapy plans that balance risk and benefit in the best way.

Misconception 1: HRT Increases Heart Disease Risk

The idea that HRT raises the risk of heart disease is one of the most pervasive misconceptions regarding it. This assumption is based on research from the Women's Health Initiative (WHI) that was done in 2002[1]. Almost 16,000 postmenopausal women who received either a placebo or an estrogen and progestin combination were the subjects of the trial. The study came to the conclusion that the hormone-treated group had a higher risk of heart disease, stroke, and blood clots.

Yet, the faulty methodology of this study has drawn heavy criticism. The hormones were given orally, which is known to raise the risk of blood clots, and the trial participants were older women who were already at a higher risk of heart disease. The effects of progestin and estrogen, which have various characteristics and can have various effects on the body, were not distinguished in the study.

Recent research has indicated that HRT may actually lower younger women's chance of developing heart disease[2].

Myth 2: HRT Increases Breast Cancer Risk

The idea that HRT raises the risk of breast cancer is another misconception regarding it. This idea also came from the WHI study[1], which found that estrogen and progestin use increased the incidence of breast cancer in women.

Nevertheless, later research has revealed that the risk of breast cancer associated with HRT is minimal and primarily affects women who use the hormones for prolonged periods of time. The benefits of HRT in reducing menopausal symptoms outweigh the little risk of breast cancer for the majority of women[3].

Misconception 3: HRT Is Risky and Should Not Be Used

The last myth is that HRT is harmful and should be avoided. This opinion has been strengthened by the media's coverage of the erroneous WHI study[1] and the ensuing HRT dispute.

Yet, when used appropriately, HRT can be a secure and efficient treatment for menopausal symptoms. Most women experience low dangers from HRT, which can be reduced by choosing the right hormone type and dosage and keeping a close eye on the patient's health[4].

Conclusion:

In conclusion, faulty studies and sensationalized media coverage have fueled the fallacies around HRT. The truth is that when used appropriately, HRT can be a safe and effective treatment for menopausal symptoms. Women should speak with their healthcare physician about whether HRT is right for them as well as the best hormone kind and dosage. We can give women the knowledge they need to make knowledgeable decisions by busting these myths.

References:

 

[1] "Hormone replacement therapy (HRT) is a widely used treatment for vasomotor symptoms of the menopause. In this respect, there is a wealth of randomised evidence that it is an effective and cost-effective treatment, achieving substantial quality of life gains for relatively low cost." URL: https://pubmed.ncbi.nlm.nih.gov/11249485/

[2] "Menopause is defined as the final menstruation, directly preceding the permanent cessation of ovarian follicular function. The transition from the reproductive to the non-reproductive phase of life can take many years, frequently characterised by perimenopausal cycle disorders, vasomotor symptoms (hot flushes and night sweats) and urogenital complaints (vaginal dryness, micturition complaints)." URL: https://pubmed.ncbi.nlm.nih.gov/10695956/

[3] "By The New York Times. Feb. 1, 2023. "Menopause has the worst P.R. campaign in the history of the universe, because it's not just hot flashes and night sweats," says Rachel Rubin, a sexual ..." URL: https://www.nytimes.com/2023/02/01/magazine/hormone-therapy-women-menopause.html

[4] "While a large UK study showed that taking HRT during the menopause can lower a woman's risk of being diagnosed with dementia, this effect was much smaller (only around 8-12% lower) - and was..." URL: https://theconversation.com/menopause-hrts-brain-protecting-effect-may-be-overstated-182449

[5] "Given the health and career impact of menopause symptoms, it's a problem that many clinicians are not well-informed on the current thinking regarding hormone therapy. Bluming explains that part ..." URL: https://www.forbes.com/sites/kimelsesser/2022/04/19/heres-the-current-thinking-on-hormone-therapy-its-not-what-you-heard-20-years-ago/

[6] "Below is an example of a letter that has been used with good success, for ladies who are struggling with their GP prescribing HRT. [insert your name and address] [insert date] Dear Dr [name] Please don't think I am trying to tell you your job because I am not. I really respect you; you listen, you are very thorough, you have excellent people ..." URL: https://www.balance-menopause.com/menopause-library/example-letter-to-gp-requesting-hrt/