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Hormone Replacement Therapy Benefits

Alex Fulton

If you’re a woman of a certain age, you’ve likely heard about hormone replacement therapy (HRT) for menopause, which is also sometimes referred to as menopause hormone therapy or MHT. HRT is a prescription treatment for menopausal women designed to address common symptoms like hot flashes, night sweats, and vaginal dryness, and in some cases, it may also provide protection against osteoporosis.1 

While many women have found HRT to be immensely helpful for relieving menopause symptoms, others are unsure of how to weigh HRT pros and cons. Some of the hesitation and confusion around HRT may be related to a landmark study called the Women’s Health Initiative (WHI). This was a large, randomized, controlled clinical trial in women ages 50 to 79 designed to study whether taking estrogen — either alone or with progestin — during and after menopause, could help women prevent chronic disease, specifically coronary heart disease and invasive breast cancer.2 

In 2002, results of the WHI study were released, suggesting HRT could increase a woman’s risk of developing breast cancer and/or heart disease. Following the release of these findings, use of hormone replacement therapy for menopause dropped by nearly 80%.3 A subsequent review of the data from the WHI, and others, have shown that hormone replacement therapy benefits for menopause can certainly outweigh the risks for some,4 and that estrogen-only HRT can actually lower breast cancer risk.5 However, many women are still reluctant to try hormone therapy because of the 2002 findings. Some may worry about side effects associated with HRT, while others may simply wish to avoid hormones in favor of a more natural approach to addressing their menopause symptoms. 

Knowing how difficult it can be to understand HRT pros and cons, we reached out to Dr. Alyssa Dweck, Bonafide Chief Medical Officer, with some questions about this complex topic. Read on to review her advice regarding HRT for menopause symptoms, as well as some treatment alternatives to consider. 

What is HRT for Menopause? 

“HRT typically refers to the replacement of estrogen, the production of which declines during menopause, and progesterone, which is added to protect the uterus from uterine cancer or precancer,” says Dr. Dweck. In other words, HRT usually means estrogen and progesterone replacement. 

“Some women, including those who have had a hysterectomy, don’t need to worry about uterine cancer prevention, and may use estrogen alone. This is known as estrogen replacement therapy (ERT),” she adds. 

Hear more from Dr. Dweck on HRT in our quick clip, below:

Hormone Replacement Therapy Benefits and Risks

Prescription hormone replacement therapy is very effective for the treatment of certain menopause symptoms, according to Dr. Dweck. “Systemic estrogen, be it in the form of a pill, patch, vaginal ring or topical gel form, works quickly to alleviate symptoms, but could pose potential risks for women, including breast cancer, blood clots, cardiovascular events, and uterine cancer; in women with a uterus. In some cases, the benefits of hormone therapy outweigh the risks, in others, not so much. Similar concerns exist for compounded bio-identical hormone products,” she adds.

What Are Hormone Replacement Therapy Benefits During Menopause? 

While there are clear benefits to HRT, there are also potential risks. “HRT is an excellent treatment option for some women since it provides significant relief of menopausal symptoms, while also offering protection against osteoporosis,” says Dr Dweck. 

Additionally, clinical studies suggest that there is no increased risk of cardiovascular disease when HRT is initiated before age 60 and/or within 10 years of onset of menopause.6 

What Are the Risks of Hormone Replacement Therapy for Menopause? 

The most notable risks of using hormone replacement therapy for menopause symptoms are breast cancer, uterine cancer, and cardiovascular events, like stroke and heart attack.7 In 2003, the Food and Drug Administration ordered all companies making drugs that contain estrogen, or estrogen combined with progestin (a synthetic form of progesterone) for menopausal women to include a black box warning, the strongest warning level a medication can receive, based on these risks. These changes were prompted by the findings of the WHI study released in 2002.8 

Are Certain Women More at Risk than Others When it Comes to Using HRT for Menopause? 

According to Dr. Dweck, HRT is not recommended for women with a history of a hormone-dependent cancer, like breast or uterine cancer. “HRT is usually contraindicated in women who have a genetic propensity towards blood clots due to the increased risk of cardiovascular disease and stroke. There is a relative contraindication for use of HRT for menopause in women who have migraine headaches with an aura because these women may have a slightly increased risk of stroke when on estrogen-containing medication.9 

Who is Most Often Prescribed Hormone Replacement Therapy for Menopause? 

“Among my patients, those who are interested in HRT are usually quite symptomatic with the iconic symptoms of menopause. This means they’re having significant and debilitating hot flashes and night sweats, with really notable interruption of sleep, and severe vaginal dryness,” Dr. Dweck says. 

She continues, “With that said, when women present in my office complaining of distressing hot flashes and night sweats, along with other common menopause symptoms, it seems some clearly want a non-hormonal option and others who will do whatever it takes to feel better. So, it's up to us as healthcare providers to present all the options — including lifestyle modification, supplements, antidepressants, non-hormonal medications, and hormone therapy of different varieties — and then discuss what might be best for that particular person.” 

Can HRT Be Used Indefinitely? 

According to Dr. Dweck, the recommendation is to individualize treatment with HRT for menopause, with an emphasis on using the lowest dose for the shortest amount of time that is appropriate to manage symptoms. A common regimen is to consider discontinuing HRT around age 60, because that's when cardiovascular risk may increase.10  But it’s important to note there is no one size fits all approach.

Are There Alternatives to Hormone Replacement Therapy? 

Because there are HRT pros and cons, some women may prefer to look for alternative treatment options. As mentioned, certain antidepressants can be very helpful for relieving hot flashes and other menopause symptoms, although they can come with their own baggage, in terms of sexual side effects, like low libido (which may already be a problem for some women during menopause).11 Gabapentin, a prescription medication often used for seizure control or chronic pain, can be very helpful for hot flashes.12 “The at bedtime dosing of gabapentin is especially helpful for those with vasomotor symptoms which interfere with sleep since it makes one drowsy,” says Dr. Dweck. 

She goes on to state, “Without question, lifestyle matters when it comes to managing menopause symptoms. I always recommend the Mediterranean diet because it's a naturally low-glycemic and cardioprotective diet. I also recommend regular exercise, as weight management has also been shown to provide benefits for vasomotor symptoms.” She concludes by stating; "I’ve also seen notable benefits and relief in my patients when using well-studied, non-drug, plant-based products, as well."

Is HRT for Menopause Right for Me? 

If you’re interested in learning more about HRT pros and cons, you and your healthcare provider should talk over your symptoms and health history and decide whether it’s right for you. If you prefer a more natural approach to managing menopause symptoms, there are plenty of effective and clinically studied options available. 




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      There is a new book called “Estrogen Matters” that analyzes the research on HRT and ERT. It makes a compelling case that it is generally safe to start within 10 years of menopause, and protective against heart disease, stroke, and even breast cancer. It’s worth a read. I hope gynecologists everywhere will read it and then either raise a legitimate challenge to it or change the prevailing protocols.

      Jessica on

      Menopause began for me at 50, the hot flashes and night sweats along with joint pain and other events were so severe, I started HRT at 53. My doctor ended this when I turned 56, and all symptoms came back with a vengeance. I did my best to muddle through for 2 years but dealt with a severe lack of sleep due to hot flashes coming on every two hours through out day and night. These were not mild fleeting flashes either, the lack of sleep was affecting all aspects of my life. I have a high stress job, and was struggling to maintain. I begged to be placed back on at least until I get close to retirement. Resuming HRT immediately ended the hot flashes and all other symptoms. I am now 60 and know it will be tough to get my doctor to let me stay on HRT for a few more years. I rarely hear others mention symptoms to the degree I experience, a lot of other women have told me the hot flashes are no big deal or they rarely have them. I wonder often if there are others that deal with this level of severity and if I am to expect this to continue into old age? Even my husband read an article stating that symptoms pass in 10 years so I should be good…. I wanted to hit him and the people who wrote the article LOL. Please post more articles about those of us who experience extreme menopausal events, I think this will assist those of us on the fringes.

      Julie on

      I did not want to do HRT because of the risk of cancer. I was prescribed Effexor for mood swings and hot flashes. I have been taking this for almost 10 years. Unfortunately my sex drive suffered and also had severe vaginal dryness. I’ve tried creams, prescription medications for vaginal dryness which in turn increased my hot flashes. Nothing had helped with my sex drive and it was effecting my marriage. My husband didn’t believe it was out of my control. Fortunately during my last well woman appointment my doctor gave me a sample of Bonafide. I was apprehensive but figured I’d give it a try. I read the pamphlet and decided I would order a 3 month supply a long with the vaginal inserts to relieve dryness. I have been taking them now for 2 months and oh my goodness, I did not think I’d ever have desire for sex again. I had pretty much came to a conclusion it was over and sex was just a chore to keep my husband happy and from straying. Can I tell you, now he is the one saying, slow down, we don’t have to do it everyday. What a change this product has made in my life! Thank you, Thank you Bonafide!

      Michelle Cossey on

      My main menopause symptom is severe vaginal dryness and UTIs. I am in my 50s. This started during Covid lockdown when it was impossible to see doctors in person. Once I finally got a doctor to look and listen to me, it was bad. I have been on HRT and I also use Bonafide too. This combo finally got me relief and the desire for intercourse again. It also stopped the frequent UTI situation I also had since the tissue down there was finally working normally again.

      Nancy on

      I, too, had many debilitating menopausal symptoms and felt HRT was very helpful in regulating those symptoms, particularly my sensitivity to heat. I had in situ ducal carcinoma and laid off the hormones but miss them every day due to the return of menopausal side effects. I realize it is not recommended in my situation, but i have considered returning to that therapy if I could regardless because I felt that much better on HRT.

      Lisa on

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