Is Hormone Replacement Therapy (HRT) for Menopause Symptoms Risky?

Question: Is Hormone Replacement Therapy (HRT) for Menopause Symptoms Risky?

My Response: Since publication of the Women’s Health Initiative (WHI, 2002), women have struggled, weighing untreated menopausal symptoms (hot flashes, mood swings, memory decline, vaginal dryness, bone and heart risk) against concerns that HRT could cause breast cancer or stroke. In the WHI study, women (average age 63) were given a placebo or oral PremPro®, a combination of Premarin® and medroxyprogesterone acetate, a synthetic form of progesterone. In a second arm of that study, women with a prior hysterectomy were given a placebo or oral Premarin® only. Compared with the placebo groups, those receiving PremPro® showed a small increase in breast cancer (seven more breast cancers per 10,000 women per year) while those on Premarin® alone showed a reduction in breast cancer incidence. Both demonstrated a small increase in blood clots. Based on that study, by 2003, there was a sharp decline in HRT prescriptions as women were advised to stop or not start HRT. In the 16 years since that study was released, significant advances in HRT safety have occurred. Bioidentical estradiol (plant based) is administered as a transdermal patch or cream, thus decreasing production of blood clotting factors released when oral estrogen passes into the liver. For those on HRT, micronized progesterone has largely replaced medroxyprogesterone acetate as protection for the uterus. Estradiol alone, or the combination of estradiol and progesterone, do not increase the risk of breast cancer. But starting HRT earlier is important. If HRT is desired, NAMS* recommends starting HRT as a woman enters menopause (on average 53 years) to maximize estrogens health benefits on bone and heart.

Author: James R. Woods, M.D.
 

*NAMS is North American Menopause Society

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James Woods | 4/18/2019

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