For years hormone replacement therapy, or HRT, was the preferred method for treating menopause. But in 2002, a nationwide study that linked HRT to an increased risk for heart disease, stroke, and breast cancer sent shock waves through the women’s health community.
In response, many women did without hormone treatments of any kind, leaving them to face menopause’s debilitating symptoms – hot flashes, mood swings, insomnia, and vaginal dryness– without relief. For a while, HRT fell into complete disrepute.
It’s taken nearly 15 years to undo the damage – and to vindicate HRT. After a re-evaluation of the 2002 study’s findings, researchers concluded that the observed health risks mainly had to do with the research participants’ age—nearly all were well over 60 and at least ten years past menopause — not with their use of HRT per se. In fact, these were not typical menopausal women, but a sub-class and their advanced age would likely have exposed them to a greater risk of major diseases anyway.
Another factor was that all of the women in the 2002 study had been treated with a single kind of HRT known as Prempro, which combines estrogen and synthetic progestin. Many of today’s HRTs combine estrogen with progesterone or estradiol, a safer mix, with no elevated risk for breast cancer.
In fact, there are some 40 other types of HRT that are tailored to different menopausal symptom profiles. These range from oral formulations to topical applications, which can be used alone or in combination. For example, women who only suffer from genital and urinary issues may find relief with trans-dermal or vaginal estrogen combined with low-dose oral estrogen.
Recent research on menopause-related cognitive impairment and mild dementia – often referred to as “brain fog” – has further validated the use of HRTs. There is also growing research on the effects of some HRT medications on anxiety and depression. For example, a study released in April 2019 showed that mid-life women treated with the HRT Tibolone for 12 weeks showed a significant reduction in their depression symptoms.
The HRT “scare” may have had a silver lining of sorts. Many women who were unwilling to endure the risks of HRTs turned to other methods – including diet, exercise, and “natural” medicines. Some studies still hostile to HRT have suggested that these other treatments are sufficient to treat menopausal conditions, which may well be true for some women.
For example, in 2017 a team of Spanish researchers led by Dr. Débora Godoy-Izquierdo head of the psychology department at the University of Granada examined the effects of regular exercise on 224 previously sedentary, post-menopausal women, ages 45-64. On average, the women reported feeling happier and more physically and mentally fit – with fewer hot flashes — as a result of their exercise program.
Some health specialists still skeptical of new and improved HRTs have also recommended “natural” hormones or bio-identical hormones compounded at special pharmacies. Alternatives labeled “natural” often sound good, in principle, but do not always pan out.
The main downside of these alternatives is that they lack the careful scrutiny that FDA approval provides. Dosage levels of hormones are critical to their efficacy — and to possible side effects. “Natural” hormone treatments can feature wide dosage variations, and carry an inherent risk. In addition, natural remedies, especially herbal supplements, can interact with prescription medications in ways that are harmful.
In the final analysis, women facing menopause should consider FDA-approved HRTs– the sooner the better. Women that start HRT within 10 years of menopause have a 30 percent lower mortality rate and 48 percent lower risk of heart disease compared to women who take a placebo, research shows.
That doesn’t mean that lifestyle changes are unimportant. Diet and exercise can only help. But they are best considered as healthy complements – not full-fledged substitutes.