HRT or No HRT? What’s the Latest Thinking?

by Rachel Goodman MD FACOG

In 2002, the Women’s Health Initiative published results of a study on the benefits and risks of hormone replacement therapy (HRT). The results indicated a reduction of osteoporotic fractures and colorectal cancer but also seemed to show an increase in coronary heart disease and breast cancer. The study was prematurely discontinued, and the media ran with it – creating panic among HRT users and forcing new guidance for doctors prescribing HRT.

The message was that the risks of HRT outweighed the benefits. But that wasn’t the whole story. Media reports didn’t specify the type of hormones prescribed, the delivery method, or the age of the women in the study, so all we heard was “HRT is bad.” And as a result, an entire generation of women lost out on the benefits of HRT and suffered as a result.

Today, we do in-depth testing on perimenopausal women and prescribe personalized combinations of hormones delivered by methods proven to protect heart health. We recommend an early start to HRT, too, generally when a woman feels changes that indicate the beginning of perimenopause. And the benefits are many: in addition to easing hot flashes, night sweats and other menopausal symptoms, hormone replacement therapy protects against bone and muscle loss, as well as heart disease.

Here are some thoughts to consider in your journey through menopause.

When’s the Best Time to Begin? Start early. In general, when you feel changes in your body that indicate you’re transitioning to perimenopause, it’s time to see your doctor about HRT. You don’t need to wait until your periods stop or the symptoms are especially bad. If you take hormonal contraception such as the combined pill, symptoms may be masked, so begin the conversation with your doctor around age 45.

What Should I Expect When Starting HRT? To start HRT, we have an in-depth consultation about symptoms and history, and make sure you’re up to date on your gyn screenings, including pap smear and mammogram. We also do a risk analysis and blood tests before prescribing a personalized dosage of hormones.

How Is HRT Delivered? Depending on what works best for you, you can choose creams, patches, troches that dissolve under your tongue, or pellets implanted under the skin, which release a steady stream of hormones over a period of time. All these delivery methods avoid metabolizing in the liver, which helps reduce the risk of blood clots.

What Hormones are Prescribed? It’s not a one-size-fits-all solution. We can prescribe a combination of estrogen, progesterone, and testosterone – and with very good compounding pharmacies, you can receive the exact dose that best serves you as your body moves into and through menopause.

What About Ongoing Care? When you’re taking HRT, we follow closely with assessments every couple months to ensure you’re responding well, then adjust dosages as needed.

It’s Not Just About the Hormones

I’m passionate about helping women navigate the significant changes of menopause, but it’s more than prescribing individualized hormonal treatment. I truly believe in a holistic approach in all stages of life and especially as we move into and through menopause. It’s a crucial time to assess lifestyle, exercise, diet and stress – and combine HRT with other modalities and access to other healers, too.

For more information about perimenopause and menopause, I recommend taking a look at The Menopause Society, which offers professional resources as well as education to help women during the menopause transition and beyond.