Is it safe to take hormone replacement therapy (HRT) during menopause?
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Dr. Mehmet Oz answered:Prior to 2002, hormone replacement therapy or HRT (now called hormone therapy) was a very common treatment for women suffering from hot flashes and other symptoms of menopause, including insomnia.
In 2002, a large clinical trial found that hormone therapy posed more risks than benefits for postmenopausal women. The study found that women taking a combination of estrogen-progestin could have increased risk of heart disease, breast cancer, stroke, and abnormal mammograms. For women who took estrogen without progestin, there was no increased risk of breast cancer or heart disease.
Despite these risks, for some women the benefits of estrogen therapy outweigh the risks. These include women who experience premature menopause (before age 40) and who are suffering from osteoporosis.
Estrogen therapy helps reduce hot flashes, vaginal symptoms, and difficulty with urination. If these factors contribute to insomnia, you might want to talk to your doctor about trying a low-dose, short-term estrogen supplement. Many women start taking estrogen supplements just to get some sleep, because sleep deprivation can lead to a host of health problems.Prior to 2002, hormone replacement therapy or HRT (now called hormone therapy) was a very common treatment for women suffering from hot flashes and other symptoms of menopause, including insomnia. In 2002, a large clinical trial found that... More -
Dr. Michael Roizen answered:Symptoms of menopause can leave women feeling scorched and doused. Hot flashes, heart palpitations and brain fog can make daily life challenging. Unfortunately, alarms about hormone therapy, also called hormone replacement therapy (HRT), have scared away many women from a treatment that banishes menopause symptoms.
An update by the U.S. Preventive Services Task Force (USPSTF) suggests that estrogen—taken alone or with progesterone—increases the risk for stroke, blood clots, and gallbladder and urinary problems. Though it does admit that its recent recommendations on hormone therapy don't apply to women thinking about HRT for menopause symptoms, or to those who have had a hysterectomy before age 50, the USPSTF has made women hesitant to take advantage of hormone therapy benefits.
If you're at increased risk for breast cancer or heart disease, HRT may not be for you (unless you do it with two baby aspirin a day). Some doctors recommend 162 mg of baby aspirin daily for everyone on hormone therapy. It decreases the risk of blood clots and cancer substantially, but check with your doctor. You may be able to use an estrogen ring (or estrogen cream) vaginally to counteract vaginal dryness, make sex fun again and keep you from peeing in your pants!
For the rest of you, oral estrogen decreases the risk of breast cancer and relieves menopause symptoms. Estrogen, or estrogen plus progesterone, reduces bone fractures and menopause symptoms, but you need the right kind of hormones. Ask your doctor about bioidentical estradiol and micronized progesterone plus 162 mg of baby aspirin.Symptoms of menopause can leave women feeling scorched and doused. Hot flashes, heart palpitations and brain fog can make daily life challenging. Unfortunately, alarms about hormone therapy, also called hormone replacement therapy (HRT),... More -
Dr. Lauren Streicher answered:I’ll give you the headline first: Estrogen and progestogen therapy started soon after menopause not only relieve symptoms, but appear safe.
The Kronos Early Estrogen Prevention Study (KEEPS) was a four-year, randomized, double-blinded, placebo-controlled clinical trial (in other words: reliable, scientific, and unbiased) of low-dose oral or transdermal estrogen and progesterone in 727 healthy women ages 42 to 58 who were within three years of the onset of menopause.
There were three groups:
- Group 1 received oral estrogen (given as Premarin, 0.45 mg/day -- a lower dose than the 0.625 mg/day used in the WHI).
- Group 2 received a transdermal estradiol (given by Climara patch, 50 µg/day (µg = microgram)).
- Group 3 received a placebo (no hormone).
Oral estrogen was associated with an increase in HDL (“good”) cholesterol along with a decrease in LDL (“bad”) cholesterol. However, there was an increase in triglyceride levels.
Transdermal estrogen did not affect cholesterol or triglycerides, and lowered insulin resistance.
The bottom line is it appears to be safe for most newly menopausal women to use hormone therapy. While both oral and transdermal estrogen have minimal risks, there appear to be advantages of transdermal estrogen therapy, particularly if a women is diabetic or at risk for cardiovascular disease.
How long can a woman safely continue hormone therapy? No one really knows, but as the study continues, that question will be answered as well.
So, there you have it. The KEEPS study researchers emphasize that hormone therapy must be individualized depending on symptoms, priorities, and risk factors. Estrogen isn’t poison, and, for the most part, miserable menopausal women can be flash-free and no longer need to feel like they are risking their lives in the name of a good night of sleep.I’ll give you the headline first: Estrogen and progestogen therapy started soon after menopause not only relieve symptoms, but appear safe. The Kronos Early Estrogen Prevention Study (KEEPS) was a four-year, randomized,... More -
Dr. Robin Miller answered:There are recommended ways to take hormone replacement therapies for menopause. In this video, Robin Miller discusses these and who should avoid HRT altogether.
There are recommended ways to take hormone replacement therapies for menopause. In this video, Robin Miller discusses these and who should avoid HRT altogether. More
