Hormone Replacement Therapy

Menopause is a natural biological process that all women experience at some point in their lives. During this time, your body goes through numerous changes as it adjusts to fluctuating hormone levels. The hormones that once existed in such vast amounts begin to dwindle as you pass childbearing years, and they’ll continue to decrease throughout the rest of your life. These changes can cause symptoms, such as hot flashes, mood swings, and even depression.

Hormone replacement therapy (HRT) can make a big difference in counteracting these symptoms by replacing the diminished hormones in a natural way. However, HRT isn’t without risks. In fact, it has been linked to an increased risk of breast cancer, heart disease, and stroke. You should carefully consider these risks before deciding if HRT is the best treatment option for your symptoms.

Types of Hormone Replacement Therapy

In the early years of HRT, doctors most often prescribed it in the form of synthetic prescription medications. These drugs are made from a blend of hormones isolated from a pregnant horse’s urine. Premarin is the synthetic form of estrogen, while Provera is the synthetic version of progesterone. Though synthetic drugs used to be the preferred HRT they’ve become less popular in recent years. Some risks were identified in clinical trials that led many women to seek out an alternative form of HRT called “bioidentical HRT.”

In bioidentical HRT, a pharmacist mixes a special blend of hormones intended to replace the depleted hormones in your body. Bioidentical hormones are generally extracted from elements found in nature. It’s believed that your body is unable to differentiate between these hormones and the natural hormones your body creates. This way of “tricking” your body into its former state has been shown to be successful in many women. However, medical researchers don’t yet know exactly how much of each hormone is needed. As a result, bioidentical HRT may involve multiple doctor visits and frequent tests to find the level of HRT dosing that’s right for you.

Since each dose varies from person-to-person, bioidentical hormones are difficult to test for safety and effectiveness on an overall basis. The lack of information on the risks of bioidentical hormones causes many women to assume that these “natural” hormones are better or safer than synthetic hormones.

However, the word “natural” is open to interpretation. Bioidentical hormones aren’t found in this form in nature. Rather, they’re made, or synthesized, from a plant chemical extracted from yams and soy. This same chemical is used in soy supplements, so bioidentical hormones are technically categorized as natural supplements. As a result, the U.S. Food and Drug Administration regulates them under a different set of rules than those covering prescription and over-the-counter drugs. This means that bioidentical hormones don’t need to be rigorously tested in humans, making it hard to know whether they’re safe or effective. Though there’s no definitive answer, most experts believe bioidentical HRT involves the same risks as synthetic HRT. Neither type of HRT is considered to be safer than the other.

Benefits of Hormone Replacement Therapy

In your childbearing years, your ovaries produce estrogen and progesterone. These hormones regulate your reproductive cycle and promote the body’s use of calcium. The ovaries decrease their production of these hormones as you age, which often results in:

  • bone loss
  • a diminished sex drive
  • low energy
  • mood swings
  • hot flashes

HRT replenishes estrogen and progesterone levels in the body, helping to reduce these effects. This type of treatment comes with other benefits as well. In addition to easing the symptoms of menopause, HRT may also reduce your risk for diabetes, tooth loss, and cataracts. Many women are able to live a more productive and comfortable life after successful HRT treatments.

While some health benefits are linked to HRT, several risks are associated with it as well.

Risks of Hormone Replacement Therapy

HRT has been connected to an increased risk for certain types of cancers, especially breast cancer. The studies that discovered a link between HRT and breast cancer refer to women being treated with synthetic HRT, not bioidentical HRT. However, there are no studies that show that bioidentical HRT is any safer than synthetic HRT. The risk of breast cancer increases the longer a woman engages in any type of HRT, and the risk decreases once HRT is stopped. 

A higher risk for uterine cancer also exists when menopausal women with a uterus use estrogen HRT only. This is why doctors will generally prescribe progesterone along with estrogen. If you’ve had a hysterectomy, you can forego progesterone and simply take estrogen.

Other risks for women undergoing HRT include osteoporosis and stroke. Osteoporosis is particularly prevalent among postmenopausal women, which is why synthetic HRT is now mostly used for short-term relief of menopause symptoms. However, it’s important to note that the risks of osteoporosis exist in menopause without HRT.

The Takeaway

Though there are risks involved with HRT, it’s still the best way to treat severe menopause symptoms and improve quality of life. You and your doctor can discuss the risks and benefits for you specifically and evaluate other treatment options. It’s critical to work closely with your doctor so you can decide what’s right for you. 

You asked, we answered

  • How long does hormone replacement therapy last?
  • There is currently no set limit to how long HRT can be taken but annual breast exams are highly recommended while taking HRT. In addition, blood pressure should be monitored periodically and any symptoms of blood clots, chest pain, or stroke should be addressed immediately. You and your doctor will need to work together to determine how long to continue your HRT.

    - Alan Carter, PharmD