Dear Doctors: Could you please write about hormone replacement therapy in menopause? It got labeled as dangerous due to a single study, which I’ve read is considered to be flawed. I started HRT before that study came out, and it saved my health, my ability to continue working and my marriage.
Dear Reader: As a woman approaches the end of her childbearing years, the levels of reproductive hormones her body produces begin to fluctuate and ebb. This transition often leads to symptoms that range from annoying and uncomfortable to severe enough to adversely affect quality of life. And because perimenopause and menopause last for years, even moderate symptoms can take a toll.
The most discussed symptoms include hot flashes, night sweats and mood swings. But the list doesn’t end there. Many women also deal with insomnia, brain fog, depression, vaginal dryness, accelerated bone loss, urinary problems, weight gain, dry skin, changes to sex drive and stiffness or pain in the muscles or joints.
Hormone replacement therapy, which is often shortened to HRT, is a decades-old approach to managing those symptoms. The treatment is just as it sounds -- the use of hormones to make up for the diminishing levels being produced by the body. Depending on a woman’s specific situation, these are estrogen and progesterone, or estrogen only.
HRT is dispensed in several ways. Higher doses are administered systemically via a pill, patch, ointment or spray. In lower-dose HRT, products such as a cream, ring or tablet are used vaginally.
While the first HRT drugs approved by the FDA date back to 1942, the treatment didn’t became widely used until the 1960s. This changed in the mid-1970s, when studies linked the HRT of the time to an increased risk of endometrial cancer. Newer research found that adding progesterone to HRT minimized this risk, and its use resumed.
This changed once again in 2002 when administrators of a study known as the Women’s Health Initiative halted their research. They announced that while HRT has benefits, they are outweighed by the risks. Specifically, the study linked HRT to an increased risk of blood clots, stroke and breast cancer. Decades later, that study is now seen as flawed, and the details of why are too complex to cover in this column.
It’s true HRT is having its moment due to news stories that have detailed certain flaws in that 2002 study, as well as misconceptions about the research in the public conversations that followed. Rather than seeing this as a green light for HRT, however, we take a more measured view.
There is no doubt that HRT can be helpful for some women. But while the health risks may not be as grave as those inferred from the 2002 study, newer research shows that some possibilities, including a small but measurable increase in breast cancer risk, do exist.
We urge anyone who is considering HRT to take this as an opportunity for a detailed discussion with their doctor about the benefits and risks of the treatment, and whether it may be the right choice for them.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
