Hormone replacementJanuary 12, 2015 January 12, 2015
This article update 3/10/2015 to include the following: Tradition HRT does not protect against Heart Disease – see the Bioidentical Hormone Replacement Therapy alternative below:
12:00 AM EDT March 10, 2015
Hormone Replacement Therapy for postmenopausal women: Does it help or harm your heart?
New evidence published today in the Cochrane Library shows that hormone replacement therapy does not protect post-menopausal women against cardiovascular disease, and may even cause an increased risk of stroke.
HRT, now more commonly known as hormone therapy, is widely used for controlling menopausal symptoms. It has also been used for the prevention of cardiovascular disease in post-menopausal women. This latest evidence looked at the effects of using hormone therapy for at least six months and involved more than 40,000 women across the world.
The length of time women were on treatment, varied across the trials from seven months to just over 10 years.
Overall, the results showed no evidence that hormone therapy provides any protective effects against death from any cause, and specifically death from cardiovascular disease, non-fatal heart attacks or angina, either in healthy women or women with pre-existing heart disease. Instead the findings showed a small increased risk of stroke for post-menopausal women.
However, other research says Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms, in particular for younger women at the onset of the menopause. This is suggested in a recent review published in The Obstetrician & Gynaecologist (TOG).
- The review highlights that menopausal symptoms,including hot flushes and night sweats are common, affecting around 70% of women for an average of 5 years but may continue for many years in about 10% of women.
Every woman experiences the menopause differently; some experience one or two symptoms mildly while others have more severe symptoms. Menopausal symptoms can be debilitating and can adversely affect a woman’s quality of life.
HRT is a medical treatment for the menopause. It provides low doses of the hormone estrogen, with or without progestogen, which a woman no longer produces.
The review notes that the risk-benefit ratio of HRT has always been debated and discusses previous studies examining the effects of HRT.
The Women’s Health Initiative Study in 2003 examined the effect of HRT on healthy postmenopausal women with a particular interest in cardiovascular outcomes. The study reported an increase in breast cancer, stroke and venous thromboembolism. Consequently, an 80% reduction in HRT use was reported. However, the re-analysis in 2007 demonstrated that giving HRT to women within 10 years of the menopause was associated with fewer risks and a reduction in cardiovascular problems.
The Million Women Study in 2001 suggested that HRT use increased the risk of breast cancer significantly and the Cochrane Collaboration systematic review identified an increased risk of similar conditions.
However, the authors of the TOG review highlight that such studies failed to address the effect of HRT in symptomatic younger postmenopausal women and have not addressed the benefits of HRT given at the window of opportunity, for example, administrating HRT for symptom relief during the early phase of the menopausal transition.
Additionally, the review advises that any woman with relative contraindications should be offered the option of discussing this further with a menopause specialist. Women with premature ovarian sufficiency should be strongly advised to consider taking HRT until the average menopausal age of 51.4 years, state the authors.
The authors conclude that doctors should not be concerned about discussing the risks and benefits of HRT with women who have menopausal symptoms, or be hesitant to offer a trial of appropriate treatment. They also emphasise that HRT is a patient choice.
In 2012, the Endocrine Society commissioned Lake Research Partners to conduct a national survey of 424 internal medicine, family practice and OB/GYN physicians about their attitudes and experiences related to treating menopausal symptoms. According to the survey, physicians say the primary barrier to women receiving hormone therapy is patients’ fears about the risks and their unwillingness to discuss the option.
Here are the bullet points from the Endocrine Society
• The vast majority of physicians surveyed (90%) say they are very comfortable talking to their patients about menopause, while fewer (71%) say their patients feel the same way.
• Data suggest women may not be talking about all of their symptoms to their doctors – particularly to male physicians. While 55% of female physicians say it is very common for women to talk to them about a lack of sexual desire as a result of menopause, 38% of male physicians say the same. Our April 2012 survey found 28% of women ages 45 to 60 are currently experiencing moderate to severe lack of sexual desire as a result of menopause.
• While most physicians surveyed (71%) have a positive impression of hormone therapy, 73% say they are prescribing the treatment at lower rates than they were ten years ago.
• Physicians say women are not receiving hormone therapy because patients are uncomfortable with the risks and are unwilling to consider the option (88%). Many OB/GYN physicians (57%) also say women are confused about hormone therapy. Only 11% of women ages 45 to 60 have a favorable view of hormone therapy.
Bioidentical hormone replacement therapy
BHRT is the use of supplemental doses of hormones that have a chemical structure identical to the hormones that the human body naturally produces. It can help alleviate the unwanted symptoms of menopause including hot flashes, night sweats, depression and sleep disturbances while improving your libido, skin texture and sense of well-being.
Treatment with bio-identical hormones is individualized according to one’s needs and symptoms, and laboratory (blood, saliva, or urine) findings. These medications are prepared by specialized, compounding pharmacies and can be delivered via capsules, topical creams or gels, oral troches, or suppositories.
Most patients are seen anywhere from 3-5 times per year, although the frequency may vary depending on one’s progress.
We place great emphasis on restoring these hormones back to levels associated with peak performance. Hormone studies may include assessment of DHEA, cortisol, pregnenolone, estrogen, progesterone, testosterone, or IGF-1 levels. These studies may be performed on blood, urine or saliva.
Our assessment will determine current hormone levels for both men and women. If deficiencies or imbalances are found, we will recommend a hormone replacement therapy that fits the patient’s individual needs. So just because aging doesn’t mean you have to feel your age.