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HRT: The (Current) Upshot

HRT: The (Current) Upshot

By Barb DePree, MD, NCMP,MMM

Created: 06/25/2019
Last Updated: 06/25/2019

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In 2013, I wrote about the conclusions a roundtable of international experts had reached about hormone replacement therapy. The gathering was put together by the Society for Women's Health Research (SWHR), an extremely reputable organization. After the roundtable, the SWHR advocated putting "HT back on the table so that women can discuss with their providers the option of symptom relief and possible long-term health benefits."

I agreed and still do. The information I've seen since then only reinforces my belief that, while it's not right for everyone, it may be right for some, and for that reason it's a conversation worth having with your health care provider, who can help you evaluate the risks for you.

Your health care provider will look at your current health—your weight (women who are 20 pounds or more overweight when perimenopausal are twice as likely to develop breast cancer after menopause), lifestyle (e.g., exercise and diet), and any menopausal symptoms, such as hot flashes and disrupted sleep.

Your health care provider will also want to discuss your family medical history, including, for example, whether any immediate family members have had Alzheimer's disease, strokes or heart attacks, osteoporosis or breast cancer. Those are not necessarily indicators that you shouldn't take HRT, as we've discussed in recent posts:

Alzheimer's:  As the authors of Estrogen Matters have pointed out, no current treatment "significantly delays or prevents Alzheimer's disease except estrogen, which can decrease the risk of Alzheimer's disease by up to 50 percent."

Heart health: The research shows that when you begin HRT when you are under the age of 60 or within 10 years of entering menopause (when you haven't had a period for 12 consecutive months), it significantly reduces coronary artery disease and overall mortality—possibly adding as many as three or four years to your lifespan, according to some experts.

Bone health: No therapy has proven to be better at preventing osteoporosis and fractures in the spine and hips than estrogen replacement therapy. For it to be entirely effective, however, women have to begin taking it in menopause and continue for the rest of their lives. We need to think of osteoporosis as a chronic condition, like hypertension or diabetes.

Breast cancer: The Women's Health Initiative found no increased risk of breast cancer when it updated its study in 2006. Furthermore, meta-analyses, which compare data from multiple studies, show that women who began HRT three to five years after their diagnoses and remained on it for an average of three years had a 10 percent decrease in chance of recurrence.

All courses of treatment have risks and benefits. My suggestion: Don't dismiss HRT because you've heard it's bad. Get the most current information. Have a conversation with your health care provider, who can help you decide what's best for you!

Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through MiddlesexMD, a website she founded and where this blog first appeared. She also is director of the Women's Midlife Services at Holland Hospital, Holland, Michigan.