Anyone who has been through menopause can attest that symptoms such as hot flashes, vaginal dryness, mood swings and insomnia can wreak havoc on your well-being. Some women even develop a sort of brain fog - leading to difficulties remembering and misplacing things.
“Some of these changes are age-related, but others are a direct result of changing hormone levels,” says Laila Shehadeh, D.O., an obstetrician and gynecologist at Henry Ford Health. "Hormone replacement therapy (HRT) is one way we are able to combat the physical and cognitive changes associated with menopause."
While there's no doubt that HRT is remarkably effective at obliterating troubling symptoms, many conflicting options and studies regarding the recommended use and safety have left women unsure about how to get relief.
Here, Dr. Shehadeh separates fact from fiction around the top questions about menopausal treatments.
Why is HRT controversial?
In 2002, results from a national study called the Women’s Health Initiative (WHI) reported that HRT could increase the risk of heart disease, stroke and breast cancer in women who took a type of estrogen and a synthetic progestin medication for more than five years. The news created a great deal of concern, but the study has since been reevaluated.
“The study focused on women over 60, not newly menopausal women,” Dr. Shehadeh says. "The media played a huge role in misrepresenting the data. In fact, research now shows that women who wait too long to start HRT or don't take it at all are actually at an increased risk for developing heart disease and osteoporosis.
Unfortunately, many women with debilitating menopausal symptoms have been suffering unnecessarily in the wake of the WHI study. The good news: getting relief now may be easier – and safer – than you think.
Does HRT increase your risk of heart disease?
No. A huge segment of the 2002 study participants (70%) were over age 60 and more than a decade past menopause. And they all took only one type of HRT (a combination of estrogen and synthetic progestin called Prempro). So, when the WHI reported that women using HRT were at greater risk for heart attacks, strokes and breast cancer, those results only applied to older women taking Prempro.
In fact, the WHI later reported that women who received only estrogen (conjugated equine estrogen-Premarin) and no synthetic progestin had fewer deaths each year for 10 years and were less likely to develop breast cancer and heart disease compared to those who received a placebo.
Women's Health At Henry Ford
Is oral HRT the only effective treatment for menopausal symptoms?
No. Newer hormone formulations, including those with lower doses and those available in different routes of delivery, offer effective relief of menopausal symptoms for many women and come with fewer side effects.
Should women who enter menopause early avoid HRT?
No. More than two-thirds of women hit menopause before age 50. For this group, initiating HRT early can be a lifesaving strategy. Research has found that women who started HRT within 10 years of menopause had a 30% lower mortality rate and 26% lower risk of dementia and 48% lower risk of heart disease compared to women who took a placebo.
Is there only one type of HRT?
No. Women today can choose from more than 50 types of HRT. Newer forms of HRT contain estradiol and progesterone – the very same molecules that women’s bodies produce naturally. 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 transdermal or vaginal estrogen combined with low-dose oral estrogen. Nonhormonal treatments are also available.
Are bioidentical compounded hormones safer than FDA-approved pharmaceuticals?
No. Many women buy bioidentical hormones (plant-derived hormones that are processed to mimic hormones found in the body) because they think they’re safe or more natural. But, because production of these products is not subject to the same scrutiny as traditional FDA-approved HRT, their dosage and effectiveness may be inaccurate. The good news is that the FDA has also approved bioidentical hormone formulations – and they’re far less expensive than the non-approved type. Any product that is bioidentical carries the same benefits and risks as FDA-approved hormone therapies produced by pharmaceutical companies.
Do lifestyle modifications work for hormonal changes?
Sometimes. For some lucky women, adopting certain lifestyle habits is enough to relieve menopausal symptoms. Proper sleep, nutrition, exercise and stress management strategies can help minimize nuisances such as hot flashes, brain fog and depression. Dressing in layers and steering clear of triggers (such as spicy food, red wine and certain food additives like monosodium glutamate, or MSG) can help cool down hot flashes.
All women, regardless of age or health status, must carefully weigh the risks and benefits of HRT. While some may be able to sidestep HRT altogether by implementing certain lifestyle strategies, it is worth it to talk with your provider to understand the pros and cons of HRT. Nonetheless, for most women, menopause is a transition and symptoms will settle down and ultimately subside over time.
Reviewed by Dr. Laila Shehadeh, an obstetrician and gynecologist who sees patients at Henry Ford Women's Health in Warren.
