Is Hormone Replacement Therapy Right for You?
If you’re like many women, you’re probably confused by the conflicting information about hormone replacement therapy. Whether you fall in the traditional or alternative medicine camp, or somewhere in between, it’s important to educate yourself about your options and what works best for your body and lifestyle.
What is HRT?
HRT is a hormone — estrogen, progesterone or a combination — used to supplement the hormones no longer made by the ovaries after menopause.
“If a woman has a uterus, she needs both,” says Dr. Lisa Grana, a Fellow of the American College of Obstetricians and Gynecologists at Triangle Physicians for Women in Cary. “Without progesterone, the lining can get too thick and she can be at risk for endometrial cancer. If she’s had a hysterectomy, she may only need estrogen.”
Estrogen comes in pill, spray and transdermal (gel or patch) forms. Progesterone comes in combination pills with estrogen, as a patch combined with estrogen, and as a compounded cream. Bioidentical hormones are chemically identical to hormones the body produces.
These hormones, both synthetic and bioidentical, are available either in a prescription form or from a compounding pharmacy.
“Some people believe compounded is safer. That’s not necessarily true,” Grana says. A prescription is Federal Drug Adminstration-approved and has gone through rigorous testing, whereas compounded forms have not had FDA testing and approval.
HRT alleviates menopausal symptoms. “Women use it to regain their quality of life, if their symptoms are so severe it impacts their daily functioning,” says Anna Garrett, a board-certified pharmacotherapy specialist, Certified Intrinsic Coach, certified valuations specialist and chief “mojo” officer at DrAnnaGarrett.com.
HRT helps prevent development of osteoporosis, vaginal dryness and pain with intercourse, and it promotes bladder and vaginal health, Grana says. If it’s started at the time of menopause, it may help prevent heart disease and dementia.
Some women experience no symptoms, or their symptoms are not debilitating, Grana says.
Cary mom Laura Heinlein thought about HRT, but never felt a need for it, even though her doctor recommended and encouraged it. “I had about eight months of serious symptoms — losing my temper, confusion, word loss, bad night sweats,” Heinlein says, but “it wasn’t so debilitating that I couldn’t handle it.”
Heinlein has adapted to hot flashes by wearing short sleeves, even in winter, and bringing a sweater or jacket. She also cranks up the air conditioning, if possible.
Other women have very severe symptoms. “In the U.S., we’re exposed to so many compounds in the environment that mimic estrogen in our bodies, attaching to estrogen receptors and blocking the action of estrogen in our bodies,” Garrett says. “We live in a chronically stressed out way, which causes our body to make high amounts of cortisol, which impacts hormone function,” she says.
Teresa McCarthy of Swannanoa had a full hysterectomy in 1994. While estrogen cured her hot flashes, she gained weight and her libido dropped. After 15 years, she stopped taking HRT to let her body rest.
The hot flashes returned, but with them came a sensation like electricity surging through her body that made her stop doing everything until it passed. She began a bioidentical hormone replacement therapy (BHRT) in 2012, and after six weeks, felt better.
“Hot flashes were gone, my energy level was up and my outlook on life was great,” McCarthy says, adding “My libido is back!”
The primary drawbacks to HRT may be increased risks for stroke, blood clots or breast cancer, Grana says.
The cost can be relatively high, whether bioidentical or synthetic, and some women don’t tolerate it well, especially if it’s not dosed correctly, Garrett says. But for many women, the pros make it worth the effort.
“There’s not a ton of cons to HRT, although there’s that subtle, low-grade fear and anxiety that if you go down the synthetic HRT road, you don’t know if you’re doing some harm to your body,” Garrett says. “This can also be true if you take BHRT because of conflicting media reports and the fact that it’s all lumped together.”
Following a total hysterectomy in 2005, Candler mom Lynn Nicolai, a nursing educator, went on a fairly high dose of estrogen. She visited the doctor several times with increasing incidents of weight gain, bloating, insomnia and depressive symptoms. She left each visit with increased estrogen doses and a prescription for sleeping pills, an anti-depressant or an appetite suppressant.
“After about six months, I was bloated, sleepless and depressed,” Nicolai says. A co-worker advised her to use a bioidentical progesterone cream to overcome estrogen dominance.
“Within two weeks, I felt much better and was losing the bloating,” Nicolai says. She researched hormones and menopause and learned that even without ovaries, other body parts produce estrogen.
Nicolai later experienced brain fog and memory issues. Her new doctor recommended synthetic hormones, which she didn’t want to take. She began using estrogen and testosterone creams, along with progesterone pills, but after three weeks, had gained eight pounds.
Nicolai now takes an oral progesterone capsule. “I just need to be very careful with estrogen because it just didn’t work for me,” she says.
Risks and Alternatives
In 1991, the National Institute of Health’s Women’s Health Initiative conducted a study on HRT. Before the study, the medical community thought hormone replacement therapy didn’t have many risks and would help people stay healthy longer. Study authors looked at just one conjugated estrogen-progestin (a synthetic progesterone) in post-menopausal women, but ended the study in early 2002.
The first phase showed an increased risk of stroke and blood clots, as well as an increased risk of breast cancer, Grana says. The results caused a lot of U.S. women to stop taking HRT. Grana notes that the average age of the women studied was 63; 50 percent were smokers or ex-smokers and 50 percent were overweight.
Other HRT options, including bioidentical estrogen and progesterone, have not been studied, Grana and Garrett point out, so risks, benefits and side effects associated with those treatments are unknown.
Data in the last 10 years shows that HRT should be started at the time of menopause, that it may prevent heart disease and that it should not be started 10-12 years after menopause, according to Grana. Most literature says HRT should be started during the first seven years of menopause. (Read more about the study at www.nhlbi.nih.gov/whi.)
Whether or not you use HRT, some simple changes can make your life and body healthier before, during and after the transition to menopause. Garrett recommends avoiding caffeine and alcohol because they can increase cortisol, and alcohol increases estrogen. She also suggests avoiding processed food because it contributes to weight gain and sugar addiction.
Try yoga and/or other forms of exercise (45 minutes to 1 hour, five days a week, plus strength training two days a week). Garrett also suggests acupuncture, known to help decrease hot flashes.
Grana talks in detail with patients about their medical, surgical and family histories. “I treat every patient on an individual basis to assess if she’s a good candidate, and review every year if she’s still a good candidate,” she says.
If you chose to do HRT, it’s best to start close to the beginning of menopause and to use the lowest dose possible for the shortest amount of time. “The key to HRT is to balance benefit to harm,” Grana says.
Cathy Downs is a freelance writer and mom to two boys. She and her family live in Cary.