What are the pros and cons of hormone replacement therapy?

Marina Johnson
Endocrinology Diabetes & Metabolism

Hormone replacement therapy (HRT) relieves menopausal symptoms for better quality of life, and reduces heart disease, Alzheimer’s and osteoporosis.

The major risk women fear is breast cancer but this risk is rare! In 10,000 women followed for 5 years who never take HRT, 30 will get breast cancer and this is considered the natural occurrence of breast cancer. If 10,000 women take HRT for 5 years, the risk increases to 38. That’s only 8 more cases!

The most common HRT, Prempro, used in the Women’s Health Initiative (WHI) is a combination pill of horse estrogen and progestin given daily. It’s been shown that giving daily progestin contributes to increased cancer. It’s safer to take progesterone over a synthetic progestin and to take it in 12-14 day cycles instead of daily. Uterine cancer can be avoided with adequate doses of progesterone or progestin. 

Oral estrogen pills cause the increased risk of heart attacks, strokes and blood clots reported by WHI. This risk is avoided by using topical estrogen in the form of pharmaceutical patches, gels, cream or mists.

Read more in my guidebook for women, “Outliving Your Ovaries: An Endocrinologists Reviews and Risks and Rewards of Treating Menopause with Hormone Replacement.”

Hormone replacement therapy is a complicated issue. On one hand, estrogen can decrease the risk of osteoporosis and vaginitis and alleviate hot flashes. On the other hand, it can increase the risk of breast and uterine cancer, heart disease, and stroke.

Hormone Replacement Therapy

  • The current recommendation is to take the smallest dose of hormone replacements for the least amount of time possible to control symptoms.
  • Reevaluate your treatment plan every six months.
  • Women with breast cancer, heart disease, or a history of blood clots should avoid hormone replacement therapy.

Whether you decide to use hormone replacement therapy is up to you. Many factors can influence your decision, like whether diseases like cancer, heart disease, and osteoporosis run in your family

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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.