Is it safe to take hormone replacement therapy (HRT) during menopause?

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

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 oral 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, but there was higher risk of uterine cancer. The North American Menopause Society found in 2017 that breast cancer risk from hormone therapy was associated with long duration of use, not short-term use.

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.

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).

In women who used either oral or transdermal estrogen, there was excellent relief of symptoms. There was no increase in blood pressure, no effects on atherosclerosis, no increase in breast cancer or uterine cancer, or blood clots associated with stroke and myocardial infarction.

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.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.