Hormone Replacement Therapy Risk
Hormone Replacement Therapy risk came to the forefront in 2002. HRT used to be the treatment of choice until the results of a long term study showed an increased risk of heart disease, stroke and breast cancer.
Indeed, it is our biggest fear that we trade the relief of hot flashes and menopause symptoms for serious health risks. What a devil’s bargain this would be!
However, a lot of the confusion comes from the reporting of the study in the media and subsequent follow-up reports. In order to get your attention, the media reports the results in a way to make them sound very sensational.
Don’t understand us wrong, there are real hormone replacement therapy risks but there where also a lot of problems with the study itself. Subsequent scrutiny of the data and the study has revealed as much.
Just after the release of the Women’s Health Study, we were told:” Hormones? No way, too dangerous!”
Now we hear from our doctors: “It depends on your health and health history.”
The current thinking is that Menopause Hormone Therapy is safe in the lowest possible dose, for the shortest possible time, as long as your health history supports it.
So what DO we know about Hormone Replacement Therapy Risk?
HRT comes in different forms, using different hormones or hormone combinations. All have their specific risks and potential side effects.
We know that estrogen stimulates the growth of tissue in the breast. If a woman has some abnormal cells in the breast tissue, she will be at higher risk of developing breast cancer. We don’t know at this time if certain types of estrogen (estradiol vs. estrone, synthetic vs. bioidentical) changes this risk.
Estrogen elevates the risk for heart attacks and stroke, especially for women who smoke or have a higher risk of developing blood clots. The risk of stroke appears to be associated with estrogen taken in pill form, especiallyconjugated estrogen (Premarin) because the liver changes the chemical structure of the hormone. Many doctors have switched their patients to estrogen patches or other forms of estrogen therapy to avoid this risk.
Progesterone, especially Progestin (a synthetic form of progesterone) also has side effects and risks. Progesterone replacement is tricky because the body does not treat it the same as the hormone that is produced in the body (even if bioidenticals are used). Progesterone replacement stays in the body longer and cause higher hormone levels, especially the progestins.
Women who still have a uterus and use estrogen have to use progesterone to avoid endomedrial cancer. All forms of progestogens (meaning the natural and synthetic hormone) have been proven to be effective. The only caveat is regarding the use of over-the-counter progesterone creams which may not contain enough active hormones to be effective to guard against endometrial cell growth.
Are Bioidenticals Less Risky?
There are also numerous, and very public, claims by celebrities thatbioidentical hormones (hormones that have the same chemical structure as the hormones in our body) are safer and will avoid the risks of traditional HRT.
It is important to distinguish between use of bioidentical hormone replacement for the treatment of menopause symptoms vs using hormones to prevent aging.
The problem with the second approach is that they are not substantiated and most scientists dispute blanket statements that bioidenticals can be taken without the same risks as traditional HRT. Bioidenticals have not been as vigorously studied as traditional HRT. So the jury is still out.
Also a lot of the claims by companies and doctors promoting bioidenticals are clearly marketing gimmicks, not sound medicine or science. Problems with the claims concern hormone testing, hormones balancing, and the compounding and quality of the hormone preparations.
Conclusion about HRT Risk
The decision to go on hormone therapy should not be made lightly. After all you are interfering with the biochemistry of your body and that can have some unintended consequences.
- HRT is a safe and good option if:
- You are suffering from moderate or severe hot flashes and other symptoms
- You stay with the current recommendations
- Your health history supports it
Always try less invasive methods (such as herbal remedies) first but if your symptoms are still interfering with your life and you have no additional risk factors, the hormone replacement therapy risk might be the lesser of two evils.
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