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Ask a WHT Doctor: Hormone Replacement Therapy

Brittaney Swift, MSN, WHNP, with Renaissance Women’s Group answers questions about hormone replacement therapy for women experiencing menopause.

What is hormone replacement therapy?

Hormone replacement therapy (HRT) is used to treat many symptoms associated with menopause. Menopause is defined as the time in a woman’s life when she stops releasing eggs and having periods. When this happens, she stops making the hormones estrogen and progesterone. Without these hormones, many women suffer from hot flashes, night sweats, fatigue, mood changes, and reduced libido. Reduction in these hormones can also increase a woman’s risk for osteoporosis, bone fracture, as well as an increased risk of developing heart disease.

Why is hormone therapy so controversial?

In 2001, findings from a large study called the “Women Health Initiative” (WHI) were released. The findings caused skepticism surrounding the use of HRT. It revealed an increased risk of cardiovascular events like heart attack, stroke, as well as a potential for increased breast cancer risk. The WHI used a particular combination of hormones, and the results were used to paint all of HRT with a very broad brush.  Subsequent studies have called the WHI into question. The North American Menopause Society (NAMS) has most recently stated that long term hormone therapy appears to be safe for many women, especially given that there are “many new options for menopausal women— lower doses, non-oral regimens, among others.”

What are the different types of hormone therapy?

Hormone therapy can be given orally or directly into the bloodstream by patches, gels or even vaginal rings.  The patch comes in a variety of doses of both estrogen and estrogen/progestin combined. It is designed to deliver hormones in a time-release fashion, keeping your hormone levels steady throughout use. The gel is applied daily and is also intended to keep blood levels of hormones very steady. A vaginal ring is worn for three months and releases a steady dose of hormones into the bloodstream.  These treatments allow the body to absorb the hormone without the liver having to break them down, which is the case with the hormone pills. Bypassing the liver allows the dose to be lowered dramatically and offers other benefits. Women’s Health Texas does offer all these options; the type of treatment is chosen by your practitioner and is determined based on your risk factors and needs.

What are the benefits of hormone therapy?

Most women report an overall better “sense of well-being,” although this is difficult to measure in studies. When given to the proper patient and started at the right time (considering age and risk factors), it can likely reduce the risk for the development of heart disease.

Other benefits include:

  • Reduction of hot flashes
  • Reduction of night sweats
  • Improvement in bone density and reduction in risk of fracture
  • Improved energy
  • Improved sleep
  • Prevention of vaginal thinning which can lead to urinary urgency and painful sex

What are the risks of hormone therapy?

The current thought is that for most women, the benefits of HRT outweigh the risks; however, it is still important for women to know that some studies have shown a slightly increased risk of heart attack, or stroke but that this is probably less of a risk with the non-oral preparations. The WHI showed an increased risk of breast cancer and many subsequent studies have refuted that and even shown some protective effect. NAMS also says that there is no reason to stop at any particular age if the hormones are still helping.   It is important that your prescriber chooses the menopause treatment that is safest given your age and risk factors.

Brittaney Swift, MSN, WHNP, says most women should discuss HRT when they become uncomfortable with menopausal symptoms, and the best person for that discussion is their women’s health doctor so an educated decision can be made. Women’s Health Texas’ dedicated providers can help you decide if HRT is a good treatment option for you. Every woman will have different needs depending on their symptoms and their risk factors. Make an appointment today to learn about your options.