Our Approach to HRT for Women

Our Approach to HRT for Women

At Modern Age, we strongly believe in the importance of supporting hormone health, particularly the hormones of estrogen and progesterone, for women as they go through the menopausal transition. This is important for both overall well-being as well as the prevention of various chronic diseases. However, many physicians remain uncomfortable with this form of therapy, in part due to outdated interpretations of research pertaining to hormone replacement therapy (HRT). There is substantial evidence that menopausal hormone replacement therapy (HRT) has important benefits for women. 

HRT helps relieve menopausal symptoms like hot flashes and vaginal dryness that can significantly reduce quality of life (de Villiers et al., Chlebowski et al.). It has also been shown to prevent bone loss and reduce fracture risk, which is a major health concern for postmenopausal women (Chlebowski et al., NAMS). HRT containing estrogen alone may even reduce breast cancer risk (Chlebowski et al., NAMS). Modern Age believes that these benefits outweigh the risks of HRT especially for women who are approaching menopause. Earlier studies in the 2000’s, such as the Women’s Health Initiative (WHI), inaccurately suggested that HRT was dangerous. There were some serious flaws with the study that led it to exaggerate the harms of HRT. The WHI used only one type, dose, and delivery method of HRT (oral conjugated equine estrogens with or without medroxyprogesterone acetate). It also did not include enough women who started HRT close to menopause, which is when benefits outweigh risks (NAMS).

Analysis of WHI data and other studies show that age and time since menopause are critical  factors influencing HRT's effects. Women who begin HRT within 10 years of menopause onset generally have fewer negative effects from HRT (Chlebowski et al., NAMS). HRT may reduce heart disease, stroke, and mortality in this population. However, risks increase if HRT is started later, especially after age 60 or more than 10-20 years after menopause (NAMS).

The delivery method of HRT also matters. Observational data suggests that transdermal HRT has less risk of blood clots and stroke than oral HRT, though confirmatory randomized controlled trials are still needed (Chlebowski et al., NAMS). The synthetic progestin component that was used in the WHI likely influences breast cancer risk, with evidence that natural progesterone is safer than synthetic progestins like medroxyprogesterone acetate used in WHI (Chlebowski et al.). At Modern Age, we use only bio-identical hormones, which do not have any of these concerns.

In summary, menopausal HRT provides real benefits to women, especially for relieving symptoms (such as hot flashes, brain fog, and mood swings) and preventing osteoporosis. The WHI unfairly exaggerated harms by using a single type of HRT in a population not appropriate for testing HRT's effects. Research since has shown that HRT is safe for recently postmenopausal women, while transdermal formulations and progesterone may be safer than what WHI tested. HRT should be individualized based on personal risk profiles and time since menopause. With a more nuanced understanding of benefits versus risks, HRT continues to be an important option for postmenopausal women. At Modern Age, we believe in HRT because we have seen the impact these treatments have had on our patients and believe that the forms in which we offer these drugs help to mitgate some of the risks associated. 

References

Chlebowski, R. T., Aragaki, A. K., & Pan, K. (2021). Breast cancer prevention: Time for change. Journal of Clinical Oncology, 17(12), 709-716. https://doi.org/10.1200/OP.21.00343

de Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C., & Pierroz, D. D. (2016). Revised global consensus statement on menopausal hormone therapy. Climacteric, 19(4), 313-315. https://doi.org/10.3109/13697137.2016.1196047

North American Menopause Society. (2017). The 2017 hormone therapy position statement of the North American Menopause Society. Menopause, 24(7), 728-753. https://doi.org/10.1097/GME.0000000000000921