Menopause is a natural biological process that all women experience as they age. However, it can come with a host of uncomfortable symptoms such as hot flashes, night sweats, brain fog, sleep disturbances, and mood changes. There are also other changes to body composition and fat deposits around the mid-section. One of the most common treatments for these symptoms is hormone therapy, also known as menopausal hormone therapy (MHT). While MHT has been shown to be effective in relieving menopausal symptoms, there has been some concern about its safety. In this blog post, we’ll explore the safety of MHT and what women should know before considering this treatment option.
First, let’s define what MHT is. It is a treatment that involves taking hormones, typically estrogen, testosterone, and progesterone, to replace the hormones that the body stops producing during menopause. This can help to alleviate symptoms such as hot flashes, mood swings, and vaginal dryness. MHT comes in various forms, including pellets, pills, patches, gels, and creams. Each has its own drawbacks that can be discussed at your initial visit.
In the past, MHT was widely prescribed to menopausal women to improve their quality of life. However, in 2002, a major study called the Women’s Health Initiative (WHI) raised concerns about the safety of MHT. The study found that women taking a combination of estrogen and progestin had a slightly increased risk of breast cancer, heart disease, stroke, and blood clots. As a result, many women stopped taking MHT, and doctors became more cautious in prescribing it.
Since the WHI study, there have been several follow-up studies that have provided more information about the safety of MHT. These studies have found that the risks associated with MHT vary depending on factors such as the type of hormone therapy used, the dose, and the duration of treatment. In addition, MHT has come a long way in the past 20+ years.
For example, estrogen-only therapy has been shown to be safe for women who have had a hysterectomy. Women who take estrogen-only therapy have a lower risk of breast cancer than women who take a combination of estrogen and progestin. However, estrogen-only therapy can increase the risk of stroke and blood clots if taken orally. Transdermal preparations such as pellets, gels and patches do not increase the risk of stroke and blood clots.
If you do take estrogen, you will often need testosterone therapy as well. This is because taking estrogen will cause a negative feedback loop to your hypothalamus (an area of the brain responsible for hormone control among other things). In addition, taking testosterone along with estrogen seems to mitigate a lot of the risks seen in the 2002 study. There are no FDA formulations for female testosterone replacement leaving us to try to give approximately 1/10 the dose that we give to men. Most women opt for pellets or dilute forms of the creams. Creams can have variable absporption rates and can transfer to loved ones so make sure to discuss this at your appointment.
Combination therapy, which includes both estrogen and progestin, has been shown to increase the risk of breast cancer, heart disease, stroke, and blood clots. However, the risks associated with combination therapy are generally small and vary depending on the duration of treatment. Women who take combination therapy for less than five years have a lower risk of breast cancer than those who take it for more than five years. There are also other options for getting progesterone into your system such as an IUD. This is only necessary if you still have a uterus or are having significant mood disturbances on estrogen alone. Most studies recommend starting MHT in the 10 years surrounding the cessation of your menstrual cycle. If you are more than 10 years into your postmenopausal years, starting MHT may not be safe for you.
It’s important to note that the risks associated with MHT are generally small and depend on individual factors. Women who are considering MHT should discuss the risks and benefits with Dr Brantly to determine if it is the right treatment option for them.
If MHT is not right for you, there are a number of plant adaptogens that you can take to help relieve symptoms.
In conclusion, MHT can be an effective treatment for menopausal symptoms, but it’s important to understand the potential risks. Women who are considering MHT should discuss the risks and benefits with their healthcare provider to determine if it is the right treatment option for them.