Should You Consider Hormone Replacement Therapy?

biodentical hormones blood clots cancer diabetes estrogen hormonal imbalance hormone imbalance hormone pellet therapy hormone replacement therapy hormones hot flashes hrt menopause osteoarthritis osteoporosis progesterone sex steroid hormones snoring stroke testosterone Mar 18, 2023

An open book opened on a page with 'Hormone Replacement Therapy' on it

During menopause, a large drop in women's sex hormone levels leads to various symptoms. Such symptoms are often associated with a decreased quality of life.¹ One way to address this problem is hormone replacement therapy (HRT). HRT is medication involving sex hormones produced outside the body. It aims to provide the lowest dose of hormones that would effectively relieve the symptoms of menopause.² In the past, menopausal women were routinely prescribed HRT. However, HRT prescriptions fell after two large studies – i.e., the Women's Health Initiative and the Million Women Study – were published. These studies reported that HRT was linked to an increased risk of breast cancer, deep-vein blood clots, and stroke.^3,4 Despite the risks, taking HRT may still be worth it for certain women. In this article, we will focus on the following factors that females must consider before deciding to take HRT:

HRT types, formulas, and dosages
Menopausal symptoms effectively treated through HRT
Common risks associated with HRT
Natural replacements for hormones lost during menopause

Let's now tackle these considerations one by one.

HRT types, formulas, and dosages

There are two main types of HRT. The first type involves estrogen only. The second one combines estrogen and progesterone. Estrogen alone works best for women who have had their uterus removed. On the other hand, the combination type is recommended for females who still have their uterus. This is because estrogen can lead to an overgrowth of cells in the endometrium (uterus lining). This overgrowth, in turn, can cause cancer. Progesterone helps decrease the risk of cancer by making the lining of the uterus thinner.⁵

HRT can be taken by mouth as pills. It can also be applied on the skin as creams, gels, sprays, or patches. Both estrogen-only and estrogen-progesterone HRT can come in these oral and transdermal formulas.^2,5 Women may get different results with different HRT types and formulas. Each woman's symptoms and risk factors must be assessed carefully before she is prescribed a specific form and dosage of HRT.²

Menopausal symptoms effectively treated through HRT

Oral HRT provides relief mainly from hot flashes. These are sudden and intense feelings of warmth, especially in upper body parts. In particular, low to standard doses of estrogen with or without progesterone make hot flashes less frequent and severe. The two types of HRT also help prevent osteoporosis (weakening of the bones) and thus, fractures. Using either type is associated with a reduced risk of type-2 diabetes as well.⁶

Therapy with estrogen only can protect against osteoarthritis. This disease causes pain and swelling in the joints, especially in the hands, knees, hips, and spine.⁶ As described earlier, HRT with both estrogen and progesterone lowers the risk of endometrial cancer. The same type of HRT can lead to a decreased risk of colon cancer too.⁶

Lastly, very low doses of transdermal estrogen relieve symptoms of vaginal atrophy. This condition happens when the walls of the vagina become thin and dry. Moreover, estrogen applied on the vagina can prevent urinary tract infections.⁶

Common risks associated with HRT

Based on studies, the benefits are greater than the risks for healthy women who begin HRT before the age of 60, or within 10 years of menopause. In contrast, women who start therapy at age 60 or beyond – i.e., more than 10 years from the beginning of menopause – are at a greater risk of certain diseases and side effects.^7,8

The use of oral HRT, whether estrogen alone or both estrogen and progesterone, increases the risk of blood clots in the leg veins. It is also linked to a higher risk of ischemic stroke (blocked supply of blood to the brain) and gallbladder disease.⁶

HRT is a risk factor for breast cancer as well. Specifically, the risk increases with using estrogen alone for more than five years. As for combination HRT, breast cancer may happen within three to five years of starting therapy; the risk continues to increase beyond that time.⁶

People generally associate menopause with a drop in estrogen levels. But the fact is, the other sex hormones -- i.e., progesterone and testosterone -- are almost gone by the time estrogen falls.^9,10 Thus, even with less total estrogen, menopause comes with a relative excess of the hormone. HRT further increases these comparatively high estrogen levels, which partly explain the health risks linked to it.

Natural replacements for hormones lost during menopause

In the United States, conjugated equine estrogens (CEEs) are the most commonly prescribed form of estrogen. They are a mixture of substances that come from horses. Synthetic estrogens like ethinyl estradiol are also used for HRT. When it comes to progesterone, one of the forms typically prescribed is medroxyprogesterone acetate (MPA). CEEs, synthetic estrogens, and MPA have different chemical structures from the estrogen and progesterone naturally found in the human body. Traditional HRT hormones thus affect the body differently compared to natural estrogen and progesterone.^5,6 The said differences in structure contribute to the health risks posed by HRT.¹¹

Because of concerns about the safety of animal-derived and man-made hormones, bioidentical hormones are becoming a popular alternative. Bioidentical hormones come from plants. They have the same chemical structure as hormones produced inside the human body. These medications can be made in standard doses by drug companies. But often, bioidentical HRT is custom-made by compounding pharmacists for patients. This means that a patient can get a specific HRT dosage and formula that would cater to her unique needs.¹²

Aside from oral and transdermal formulas, bioidentical hormones are also available as small pellets that can be inserted under the skin.¹³ Unlike pills, creams, gels, or sprays, hormone pellet therapy allows the slow and steady release of hormones. So, it can be a safer and more comfortable option than taking HRT by mouth or applying it on the skin.¹⁴

Conclusion

HRT can be great for relieving symptoms of menopause. However, the standard formulations can heighten the relative excess of estrogen that naturally comes with menopause. What's more, traditional HRT hormones have a different chemical structure from the ones naturally produced by the body. For these reasons, HRT is linked to certain health risks. These risks could be minimized by choosing to take bioidentical hormones, such as those injected under the skin through hormone pellet therapy.

In addition to the health risks already described, excess estrogen also contributes to sleep issues, including snoring. Check out The Snoring Diet Solution to learn more.

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