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Is Menopausal Hormone Therapy Safe?

The number one question we get, is what you're about to embark on 'safe' - and while we hope you trust our DECADES of medical expereince, we totally understand you want the facts, and so we wrote it all out below!

In short, very, here's all the research we've done!

Are you experiencing symptoms of menopause but concerned about the potential dangers of hormone replacement therapy (HRT)? Perhaps you've heard alarming claims about its association with breast cancer and heart attacks, and even your doctor may have advised against it. As a result, you endure uncomfortable hot flashes, vaginal dryness, fatigue, depressed mood, irritability, poor sleep, and various changes in your hair, skin, sex life, and body shape. These symptoms may be adversely affecting your family, career, and overall quality of life.

We share your frustration upon learning about the suffering women endure in such situations because the risks of estrogen replacement therapy have been greatly exaggerated, misinterpreted, and misunderstood. Contrary to popular belief, numerous studies consistently show that estrogen replacement is not linked to an increased risk of breast cancer. Furthermore, estrogen has actually been proven to reduce the risk of heart attacks and mortality.

Let's delve into the underlying reasons for this discrepancy. One study conducted at Yale focused on women aged 50-59 who had undergone a hysterectomy. Surprisingly, estrogen therapy (ET) was associated with a decrease in deaths caused by heart attacks and breast cancer in this particular group. In fact, it was estimated that 90,000 women have lost their lives due to the discontinuation of hormone replacement therapy—an alarming revelation indeed.

The Women's Health Initiative Trial (WHI) is the study that ignited the controversy surrounding HRT. In this study, women were given a non-bioidentical form of estrogen (meaning it was not exactly identical to the estrogen produced by the ovaries) along with a synthetic progestin (a man-made chemical that mimics natural progesterone). The synthetic progestin was the primary culprit, contributing to increased risks of breast cancer and heart disease. However, for now, let's focus on estrogen, as it is the hormone that has been unfairly stigmatized.

Here's what we know: estrogen is beneficial for maintaining bone health and is the most effective treatment for alleviating hot flashes. These facts are well-established. Additionally, there are several crucial factors to consider when it comes to hormone replacement therapy:

  1. The timing of initiating hormone replacement is significant.

  2. The method of administration plays a role.

  3. The specific form of hormone replacement matters.

Let's explore each of these factors to empower you with comprehensive knowledge.

Timing is crucial when starting hormone replacement. In the WHI study, women who received estrogen-only therapy (those who had undergone a hysterectomy) experienced fewer cases of heart disease, strokes, breast cancer, and overall mortality when they started hormone replacement between the ages of 50 and 59. Similarly, women who started between the ages of 60 and 69 had lower rates of heart disease and breast cancer but a slightly increased risk of blood clots and strokes. Notably, overall mortality did not significantly change when compared to women who did not receive hormone replacement therapy.

For women who initiated estrogen-only therapy at older ages (between 70 and 79), there was an increased risk of blood clots, strokes, heart disease, and overall mortality. However, there was no heightened risk of breast cancer. Commencing estrogen replacement within 10 years of menopause provides the most favorable outcomes, as it decreases the risk of heart attacks, strokes, and mortality.

The Endocrine Society interprets this data as follows: "Heart attacks, heart failure, and death are reduced by 40% when HRT is initiated in women aged less than age 60 or within 10 years of menopause."

It's essential to note that the decrease in breast cancer risk occurred regardless of the age at which women started hormone replacement. This information is derived from the same WHI study that gained significant media attention for its association between hormones and breast cancer.

The method of hormone replacement therapy (HRT) administration plays a crucial role in its effects on the body. It's important to be aware of these considerations:

  1. Oral estrogen, especially if it is not bioidentical, can increase the risk of blood clots. This risk is further heightened when combined with a synthetic progestin. Additional factors that contribute to this risk include age, obesity, and smoking. Less common risk factors, such as Factor V Leiden, should also be taken into account.

  2. Transdermal estrogen (absorbed through the skin) does not increase the risk of blood clots. Therefore, avoiding estrogen pills can significantly reduce this risk, particularly in women with additional risk factors.

  3. Synthetic progestins, including those used in the WHI study, slightly increase the risk of breast cancer. However, estrogen combined with bioidentical progesterone (which matches the hormones naturally produced by the ovaries) does not raise this risk. Estrogen alone, without progesterone, can even decrease the risk of breast cancer.

  4. Using estrogen alone for more than 10 years may lead to a slight increase in breast cancer risk. Additionally, using estrogen alone can increase the risk of uterine cancer. To mitigate these risks, combining estrogen with bioidentical progesterone is recommended, as it helps prevent uterine cancer.

  5. Dr. Josh Trutt has provided valuable insights on how to interpret studies related to hormone replacement therapy. Some key points he highlighted include:

  • Blood clot risk does not increase when transdermal estrogen is used instead of oral estrogen in women with additional risk factors like hypertension, obesity, or smoking.

  • If transdermal estrogens were used in women within 10 years of menopause, the risk of heart disease would decrease, unlike the findings of increased risk seen with oral estrogens in women more than 10 years after menopause, particularly those with other risk factors like smoking, hypertension, and obesity.

  • Breast cancer incidence does not increase when bio-identical progesterone is used, whereas synthetic progestins are associated with a slight increase in risk.

  • Estrogen alone or combined with bio-identical progesterone can decrease the risk of breast cancer.

  1. Regarding dementia, estrogen is known to protect memory. The WHI study attempted to prove this, but instead found an increase in dementia in women as early as 12 months after starting HRT. However, there was no increase in mild cognitive impairment, which typically occurs in the early stages of Alzheimer's disease. This suggests that the dementia observed in the study may not have been caused by Alzheimer's. It is likely that the older women in the study, who started hormones and had additional risk factors like oral estrogen and synthetic progestins, experienced mini-strokes leading to the onset of dementia. Studies have shown that using transdermal estrogen (with a lower risk of blood clots) and starting estrogen at a younger age can significantly reduce the risk of dementia.

  2. Several studies have demonstrated the benefits of hormone replacement therapy:

  • A Danish study involving 1,000 women who were within a few years of menopause showed a 50% reduction in heart attacks, heart failure, and death among those receiving hormone replacement with oral bioidentical estrogen (and synthetic progestins for women with a uterus) compared to the control group. Women taking estrogen alone or combined with progestins did not experience an increase in breast cancer risk.

  • A Finnish study of nearly half a million postmenopausal women showed that hormone replacement with estradiol (bio-identical estrogen) reduced the risk of death from heart disease by 18-54% and stroke death by 18-39%. 

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