Hormone Replacement Therapy: A controversial history with a happy ending

Hormone replacement therapy (HRT) for peri and post menopause has been a heavily debated topic over the last 2 decades.  Not until the last number of years has it begun to rise in popularity again as the myths and misunderstandings from earlier research have been brought to light.   
​
Here are some facts:

• HRT began in 1923, at that time it was known as PREMARIN – derived from pregnant mare (horse) urine. 
• In 1998, everything changed when the Women’s Health Initiative launched the first randomized controlled trial (the gold standard for medical research).
• In 2002, the study was halted and their early findings were released – that hormone replacement therapy increased breast cancer risk. 
• 80% of worldwide HRT was stopped and from 2002 on, very few peri or menopausal women were offered HRT to treat their troubling symptoms. 
• Due to biased media coverage at the time, the complexities and details of the actual results of this study were lost. 
• Later reanalysis of the data showed that there are protective benefits of HRT on lowering colon cancer risk, osteoporosis, and heart disease. There was a small increase in risk of breast cancer and stroke.
• HRT also showed benefit in reducing hot flashes, night sweats, improving sleep, genitourinary symptoms, offered bone protection, and helped cognitive function and mood.  
• To put the breast cancer risk into perspective, the risk of breast cancer in the general population (not on HRT) is 4/1000 women.  When HRT is added, the risk becomes 5/1000 women. No increased risk of breast cancer was found within the first 5 years of treatment. 

 
Now that the history is out of the way, here are some thoughts on present day usage of HRT:

Why do we consider “replacing hormones?"

• Symptom management and quality of life in perimenopause and menopause
• Early onset menopause to reduce risks of lowered hormones at a younger age
• Hysterectomy before menopause – with or without ovaries
• Vasomotor symptoms – hot flashes and night sweats
• Prevention of osteoporosis
• Genitourinary symptoms – frequency, urgency, burning, UTI’s, vaginal dryness, and pain. 

Who is not a candidate for HRT? 

• Menopausal women who are greater than 10 years from menopause should be cautious as it can increase risk of heart disease, stroke and breast cancer.
• Known or suspected breast cancer or hormone sensitive cancer
• Undiagnosed abnormal vaginal bleeding
• Known blood clotting disorder
• Prior allergic reaction to hormone medications
• Liver disease

There are so many things to consider in the choice to try hormone replacement therapy.  Every woman deserves the discussion, taking into account their individual risk factors, family history, and current medical status.  I’m happy to have a discussion on the pros and cons of HRT and whether it is the right choice for you.  

But the bottom line is: Despite a rocky past, if you are suffering from distressing symptoms that are affecting your quality of life, consider HRT an option until proven otherwise.