It’s unfortunate in some ways that the medical community, and women themselves, have taken the view that menopause is a medical condition that needs treatment. While some of the symptoms of menopause do impact the quality of your life such as sleeplessness, hot flashes and depression, it’s also a fact that it’s a necessary part of the aging process. True some of the potentially more dangerous conditions of menopause, such as depression and osteoporosis, may need to be dealt with medically, but as with all medical treatments comes the fact that the cure may be worse than the “disease”. And this has proved true in the case of hormone replacement therapy (HRT).

For years, the best medical treatment recommended for menopause
was the use of HRT, but in 2002 all of this began to be questioned when the US government stopped a drug trial of the Women’s Health Initiative (WHI) to test the uses of hormone replacement therapy. Evidence began to emerge that HRT caused an increase in breast cancer, heart disease, blood clots, strokes, and endometrial cancer. Even though this study also showed HRT use decreased osteoporosis risk and maybe also colon cancer, in 2002, the cons began to outweigh the pros and women began to reject HRT.

More information is available for women today due to new studies and tests, but there are still questions and concerns regarding HRT. A study conducted by WISDOM (Women’s International Study of Long Duration Estrogen after Menopause) started in the early 1990’s was closed early due in part to the problems found in the WHI study but WISDOM was breaking down HRT use by the age and was getting some more promising data on the use of HRT. The Women’s Health Initiative studied women aged 50 – 79 years old and the study reflected the long term effects of HRT use but not short term use by women just starting menopause. Unfortunately both of these studies left questions. Two questions listed in the WISDOM study as specifically not addressed are: 1) What is the long term effect of HRT if started at the onset of menopause? 2) Are there differences among the various types of HRT available?.

HRT is still in use today, but it is generally only recommended for short term use, usually one to two years for women who are under going natural menopause. Young women having surgical menopause brought on my hysterectomy or other procedures stay on hormone replacement therapy longer, sometimes until the onset of natural menopause.

HRT has many different forms and many different delivery systems. It usually includes a low dose estrogen with progesterone, or sometimes a synthetic progesterone, called progestin may be used. Testosterone is sometimes included in the treatment and this is used to help treat loss of sexual desire. Various combinations of these hormones may be given depending on what your doctors feels is the best way to proceed. Delivery systems include pills, creams, patches, IUDs, vaginal rings and sometimes shots.

 HRT Risks:

• Breast cancer
• Ovarian cancer
• Gallbladder disease
• Moodiness
• Water retention
• Nausea
• Blood Clots
• Heart Attacks
• Strokes
• Breast sensitivity

Some of these side effects depend on the type of dosage and delivery system used. For example, creams and gels might upset your stomach. Also, these risks depend on the type of estrogen or progesterone taken. Conjugated equine estrogens (CEE) have been the most prescribed HRT so most of the current testing has been done on them and because most of the studies conducted have been done on equine estrogens, only the side effects and risks attributed to these estrogens are known. These same risks are not applicable to bioidentical human estrogen and more studies still need to be conducted as these treatments are gaining in popularity.

Only a discussion with your doctor can help you decide if HRT is the choice for you. If you do have a family medical history of cancer or any of the other HRT risks listed above, be sure to discuss this with your doctor.