Separating Fact from Fiction About Hormone Replacement Therapy (HRT)
By: BioDesign Wellness Center Staff
March 11, 2020 | Category: HormonesRequest A Call From Us
There’s still a lot of confusion these days about Hormone Replacement Therapy, especially here in Tampa where a Google search reveals hundreds of paid advertisements and questionable search results. It’s no wonder so many people are confused about Hormone Replacement Therapy.
Why have things become so complicated? To answer that question, we have to take a slight detour through the somewhat recent annals of medical research, focusing first and foremost on the Women’s Health Initiative Hormone Therapy Trials.
Hormone replacement therapy (HRT) became a popular and effective treatment in the mid to late 20th century for menopausal and post-menopausal symptoms including hot flashes, night sweats, sexual dysfunction, sleep disturbances, mood changes, urinary incontinence, cognitive disturbances (memory loss and impaired concentration), and weight gain.
However, starting in the 1970s, several studies drew concern over the potential health risks of HRT, including increased risk of breast cancer, ovarian cancer, blood clots, heart disease, and stroke. One study in particular sounded the alarm over HRT — the Women’s Health Initiative (WHI) Hormone Therapy Trials. Between 1993 and 1998, 27,347 U.S. women ages 50–79 enrolled in the study — 16,608 with a uterus in the trial of estrogen-plus-progestin and 10,739 without a uterus in the trial of estrogen-alone.
The study ended in 2002 for the estrogen-plus-progestin group and in 2004 for the estrogen-only group when they were told to stop taking their study medication due to the increased rates of serious health conditions among those taking hormone medication compared with those taking placebos. Study participants receiving HRT exhibited an increased incidence of coronary heart disease, stroke, breast cancer, blood clots in the lungs, colorectal cancer, endometrial cancer, hip fracture, and death. (Endometrial refers to the mucous membrane of the uterus.)
The results of this study, more than any other, caused a steep decline in the use of HRT that persisted for decades. Doctors and patients still cite this study to us here at BioDesign Wellness as a reason for their reluctance to consider HRT as a treatment option. However, the results from this study do not tell the entire story. In fact, they are very misleading. As a result, many women in perimenopause, menopause, and post-menopause are suffering needlessly due to misplaced fears over potential risks of HRT.
Problems with the Women’s Health Initiative Study
In the 15+ years since the study ended, further research on the potential benefits and risks of HRT have been done highlighting limitations of the WHI study, including the following:
- On average, women in the study were 63 years old and 13 years from menopause. The WHI findings do not shed light on the potential benefits and risks for younger women with menopausal symptoms.
- Most of the women in the study had no symptoms of menopause, so the HRT may have raised their hormones to unhealthy levels.
- The women were given synthetic equine estrogen in the form of oral Prempro, so potentially safer alternatives were not considered, such as bioidentical hormones or transdermal patches.
In short, we do not feel it’s wise to use the results from the WHI study to weigh the potential risks and benefits of HRT in younger women with menopausal symptoms using today’s HRT options.
What Current Research Shows
Based on more current research, we now know that the potential benefits of hormone replacement therapy outweigh the risks for treatment of hot flashes, sleep disturbances, and prevention of bone loss among women who meet the following criteria:
- Younger than 60 years old or within 10 years of menopause onset
- No contraindications to HRT, such as a history of breast or endometrial cancer
Hormone replacement therapy has been proven to deliver the following benefits:
- Alleviates menopausal symptoms
- Helps to maintain bone density and reduce fractures
- Supports weight loss and helps to eliminate belly fat
- May improve muscle mass and strength
Minimizing Risks While Maximizing Benefits
The key to successful hormone replacement therapy is to minimize risks while maximizing potential benefits, which we do here at BioDesign Wellness by taking the following approach:
- Consider the age of each patient and the time from the onset of menopause.
- Examine the symptoms and unique health risks for each individual patient. No two patients are identical, so the decision of whether HRT is right for a patient and the specific treatment protocol needs to be tailored to the individual.
- Test hormone levels prior to and during treatment to maintain the proper dose of each hormone and prescribe the lowest effective dose.
- Choose the best delivery method, such as transdermal patches, oral medications, topical applications, implants, or a combination.
- Test and treat for underlying conditions that may cause or contribute to low estrogen or progesterone or any conditions that could increase the risk of HRT.
Note: If symptoms are limited vaginal dryness and painful sex, systemic hormone replacement therapy may not be necessary. Vaginal estrogen and other products can be much safer and just as, if not more, effective.
In recent years, the medical community has developed a deeper understanding of the health risks of HRT regarding specific conditions. This deeper understanding enables us to make well-informed treatment decisions to mitigate these risks, which include the following:
- Breast cancer: Beyond seven and a half years of continuous use, estrogen plus progestogen HRT may be associated with one additional breast cancer case for every 1,000 women over age 50 with no increase in overall mortality. In comparison, postmenopausal obesity or two or more alcohol drinks per day is associated with a greater risk. Estrogen-alone HRT (such as when the uterus is removed) is associated with a reduction in breast cancer risk. In addition, the risk for combined HRT returns to baseline after stopping HRT, which suggests that it promotes breast cancer but doesn’t act as a trigger.
- Cardiovascular disease (CVD): Increased risk of CVD with HRT is age dependent. For women under the age of 60, HRT does not pose an increased risk. In fact, it may be beneficial to heart health in women under 60 within ten years of menopause.
- Deep vein thrombosis (DVT) / Pulmonary embolism (PE): While the risk of DVT/PE is increased with oral estrogen, this risk is no higher than in the general population when other estrogen replacement therapies are used, such as low-dose transdermal estrogen.
- Endometrial cancer: The risk of endometrial cancer is increased with HRT only if the uterus still present and only estrogen is given. Adding bioidentical progesterone helps to mitigate the risk.
Supporting Weight Loss and Fitness
Two of the most attractive benefits of hormone replacement therapy — for both women and men (testosterone replacement in men) — are medically supervised weight loss and fitness-related reasons. As we age, our hormone levels decline, and, as a result, we’re more susceptible to weight gain, especially in the form of increased belly fat. While HRT may increase the susceptibility to certain conditions, carrying extra weight, especially around the waist, increases the risk for breast cancer, diabetes, heart disease, and various other illnesses. In addition, it can make us feel bloated and less motivated to engage in the physical activities that keep us young and fit.
When we were young, losing weight was easier. We could diet and exercise the pounds away. As our hormone levels decline over the years, losing weight gradually requires more effort and energy, which we have less of due to the decline in hormone levels. We try harder to lose weight and build muscle mass and endurance with less satisfying results.
HRT can help restore our vim and vigor and ease the process of losing weight.
The BioDesign Wellness Approach to Hormone Replacement Therapy
At BioDesign Wellness Center, we take a step-by-step, layered approach to balancing hormones that we liken to baking a cake (which is admittedly a little odd since we were just discussing weight loss). The initial layers or basic ingredients include medical and family history, lifestyle coaching (including exercise and stress management), nutritional assessment and counseling, supplementation to restore optimal cellular function, testing for and correcting any deficiencies, improving sleep. These initial layers form the cake and provide a firm foundation for balancing hormones.
Hormone replacement therapy is the icing on the cake. While the basic ingredients restore fundamental health and function, bioidentical HRT (BHRT) takes you to the next level, making you feel younger, stronger, happier, and lighter. Bone density, heart health, and sex drive improve.
This is quite different from just throwing hormones at a symptom or health concern. A thorough and well thought out plan makes all the difference when it comes to balancing hormones and feeling yourself again.
We take a collaborative approach to restoring health and fitness. Considering family history, medical history, current symptoms, stress levels, diet, lifestyle, and other factors, we tailor the treatment plan to each patient’s needs, abilities, and health and fitness goals. And we test before we treat, so we can identify the root cause of any illnesses or imbalances and treat those instead of merely suppressing symptoms. Each plan is individualized to meet the needs of each patient in the safest and most effective manner possible.
We encourage you to take the first step to feeling your best again. To schedule a wellness evaluation in our Tampa functional medicine clinic, please contact our customer experience manager, Lori, at (813) 445-7770.
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Disclaimer: The information in this blog post about Hormone Replacement Therapy (HRT) is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from the medical staff at BioDesign Wellness Center, Inc., nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.