It’s been a bumpy ride for proponents of hormone replacement therapy since 2002. That was the year a landmark study by the Women’s Health Initiative found the controversial treatment – once favored as a remedy for menopause symptoms – increased risk of breast cancer and stroke.
Sales plummeted, and have not been helped by further studies, including two this year, which linked hormone replacement therapy to intestinal bleeding, and no benefits when used for health of the heart.
There are no easy answers with hormone replacement therapy. We know the treatment works for menopause symptoms, but HRT appears to be on the downward slope of approval from both researchers and the doctors who used to approve it.
If you’re thinking of hormone replacement therapy, your doctor will need to assess your age, health conditions and family history of breast and ovarian cancer. And he’ll likely have you on a small dose and for the shortest time possible.
First, some basics. Hormone replacement therapy uses synthetic female hormones estrogen and progesterone, typically to address menopause symptoms from lower estrogen as a result of ‘The Change’.
In women of child-bearing age, estrogen prepares the uterus for a fertilized egg. As well, it controls how the body uses calcium. That’s why the effects of menopause tend to be so pronounced – estrogen influences everything from bone density to cholesterol. And that’s why hormone replacement therapy was such as hit – at least until the 2002 study that scared folks away.
Women who pursue hormone replacement therapy have two options:
Estrogen Therapy – The two most common forms of estrogen therapy are as a daily patch or pill. You can also get estrogen therapy as a vaginal ring, cream or spray. In any event, your doctor will probably recommend a low dose of estrogen therapy if you’ve had a hysterectomy.
Estrogen/Progesterone/Progestin Hormone Therapy – Often called ‘Combination Therapy’ because it combines estrogen with a synthetic form of progesterone, called progestin, this form of HRT is meant for women who still have their uterus.
To elaborate on the latter option, estrogen therapy without progesterone increases risk of endometrium cancer in women with their uterus once menstruation stops because the cellular build-up can lead to growth in the uterus lining. Progesterone thins this lining – the endometrium – so that growth because less of a risk.
That’s the million dollar question. Our current understanding of hormone replacement therapy leans to ‘maybe ‘ – but that needs to be evaluated on a case-by-case basis.
Perhaps the more relevant question is whether the benefits of hormone replacement therapy outweigh the risks. Studies suggest HRT increases risk of stroke, breast cancer, blood clots and colitis – and it does little to help brain function or protect against heart disease, though it seems to work for vaginal dryness.
Some women should rule out HRT completely. Those include women with active or previous strokes, blood clots, cancer, heart or liver disease, heart attack and/or known or suspected pregnancy. The treatment may have other risks too that we still don’t know about – yet another reason why HRT should be weighed against each woman’s medical history.
We already know hormone replacement therapy may lead to blood clotting. Now researchers believe that may have implications in the GI system as well. A study published in May 2015 found HRT increased risk of bleeding in the large intestine because of a condition called schematic colitis, which develops when clots attack blood vessels in this vital area.
In turn, this kills the affected part of the intestine. That’s what causes the GI bleeding – although these results are preliminary until they’re published in a peer-reviewed journal.
A study published in May 2015 found HRT increased risk of bleeding in the large intestine because of a condition called schematic colitis, which develops when clots attack blood vessels in this vital area.
The study consisted of data collected on roughly 74,000 women. Of those, researchers compared episodes of gastrointestinal bleeding in women who’d used hormone replacement to those who’d never used it. The results: patients had a 50% higher risk of GI bleeding compared to women in the latter category.
Women who’d used hormone replacement therapy in the past, but not actively, were 20% more likely to have the ailment. As well, women using HRT were twice as likely to have ischemic colitis and lower intestinal bleeding, though no difference was seen between the two groups in bleeding of the upper intestinal tract.
Risk of bleeding was proportionate to length of treatment. The longer a woman had used hormone replacement therapy, the greater her chance of intestinal bleeding.
Hormone replacement therapy took another blow recently with still more studies that suggest it’s of little use other than for menopause symptoms. A study published in 2013 found estrogen therapy was ineffective for cognitive decline in women post-menopause. And yet another study – this one in March – found it failed to offer protection for the heart.
This was a review of collected studies on the subject; it found that HRT did not help women fend off heart disease after menopause and may even increase risk of stroke. That risk may vary according to the patient’s age when she begins hormone replacement therapy, however, say the researchers, who call this the ‘timing hypothesis’.
For certain women in early menopause, HRT may be helpful and those risks may be unwarranted according to the study, published March 10 in the journal Cochrane Library.
In this review of evidence, researchers analyzed data from a variety of studies, including one from more than 40,000 women around the globe. The women involved had taken hormone replacement therapy between seven months to over ten years.
Overall, the results found no evidence that HRT lowered risk of death from any cause, including heart disease or non-fatal heart attack or angina. In fact, it had the opposite effect. Hormone replacement therapy slightly increased risk of stroke, like it did in the WHI 2002 study. But timing mattered – there was some evidence that women who started hormone therapy within the first 10 years of menopause appeared to have slight protection against death and heart attack.
But they had higher risk of blood clots with it. And the findings suggest those gains are nullified and risk goes up once again if hormone replacement therapy is used beyond menopause.
That’s a conversation you’ll want with your doctor. Based on our most recent understanding of HRT – and the increasing volume of studies performed on the subject – it’s effective for early menopause symptoms, but should be used at a low dose and for the shortest time possible.
It’s not our place to say whether you should do hormone replacement therapy. We don’t know your medical history, and it’s possible your doctor may suggest you do HRT for reasons not mentioned in this article.
Our stance continues to be the risks of hormone replacement therapy come with baggage we’re not keen to carry. And we’ve written several articles on natural alternatives to HRT and ways to alleviate vaginal dryness.
Many women find Provestra helps with some menopause symptoms because it has black cohosh, and HerSolution Gel when passion gets painful.
Both are natural-based supplements available here at Natural Health Source.
Keep in mind too that timing seems to be at work with hormone replacement therapy. The studies suggest you’ll have the most benefit within early menopause. Your doctor can help guide you with this decision as you make the transition to the next phase in your body’s journey through life.