What is menopausal hormone therapy?
Is it a viable treatment option for managing menopausal symptoms?
Does it lead to breast cancer?
What about Cardiovascular disease?
These are questions many women in midlife have that a lot of primary care physicians aren’t comfortable answering due to a lack of knowledge on the subject.
In 2002, there was an inaccurate study led by the Women’s Health Initiative (WHI) that caused many women to believe that MHT led to an increased risk of breast cancer and cardiovascular disease. The inaccuracies in the study were later clarified by newer studies that demonstrated the safety of MHT for women younger than 60 who are in good health, and within 10 years of menopause.
However, there are still many myths circulating about MHT, and many women wonder if it actually a safe option for treating their menopausal symptoms.
My goal is to answer the most common questions women have about MHT, and dispel some of these myths. In this article I will discuss the benefits and risks of MHT, symptoms MHT can help with, and what types of MHT are available so you can have more clarity on the subject overall.
Menopausal Hormone Therapy — what is it?
Previously referred to as Hormone Replacement Therapy (HRT), Menopausal Hormone Therapy is a term that encompasses the two different types of hormone treatment that are available that help alleviate hot flashes, loss of bone density, night sweats, and genitourinary symptoms of vaginal dryness.
There are two types of MHT; estrogen-progestogen therapy (EPT) and estrogen therapy (ET).
Estrogen-progestogen therapy is prescribed for women who still have their uterus because progestogen prevents hyperplasia (a build-up of cells) in the inner lining of the uterus. Essentially, it works to counteract the effects that estrogen has on the endometrium (the inner layer of the uterus) by regulating the amount of estrogen hormone receptors available in the tissue, which significantly decreases the risk of endometrial cancer.
Estrogen Therapy is the use of estrogen alone and is given to women who have had their uterus removed.
So, why is estrogen so important?
Well, as women, in the years leading up to menopause (also known as perimenopause) our bodies begin to produce less estrogen which lead to the symptoms we experience during menopause.
Estrogen has the ability to reduce the frequency and severity of some of these symptoms, including:
It also helps to increase blood flow in the brain, improve brain connectivity (allowing different parts of the brain to communicate with each other), and may even reduce the buildup of plaques in the brain that have been linked with Alzheimer’s disease.
Studies conducted by Dr. Lisa Mosconi (the director of the Women’s Brain Initiative at Cornell Medicine) and her team have shown that the longer a woman’s brain is exposed to estrogen the stronger it is, and may have a lower risk of dementia.
When is it best to start MHT?
The North American Menopause Society (NAMS) states that MHT is best for women younger than 60, or who are within 10 years of menopause, and have no high risk health conditions or contraindications.
It is recommended for those who have already tried low-dose vaginal estrogen, but have not seen an improvement in hot flashes, bone loss, and vaginal dryness or painful sex.
I highly recommend regular periodic evaluations after beginning MHT to ensure that it is managing your symptoms effectively, and that the right dose is being administered.
If you are experiencing vaginal dryness or painful sex, I would recommend trying over-the-counter vaginal moisturizers and lubricants before considering MHT. If these don’t provide relief, then consult your physician to see if other therapies like MHT are the right fit for you.
When is it best to stop MHT?
There really is no concrete answer for this because every woman’s body is different. This is a decision that should be made between a woman and her doctor based on her medical history and what is best for her specifically.
What are the risks of MHT?
As I mentioned earlier, many women think that MHT can increase their risk of breast cancer and cardiovascular disease. However, in reality, this depends on the woman and how longs she uses MHT.
The risk of breast cancer for the majority of women using MHT is extremely small. Estrogen-progestogen therapy (EPT) only slightly increases one’s risk of breast cancer if it’s used for more than four to five years. Women using estrogen alone (remember, this is only for women who have had hysterectomies) only have an increased risk of breast cancer if it’s used longer than seven years.
Regarding cardiovascular disease, MHT may have negative effects that lead to its progression when it is initiated among women older than 60 years of age, or women who have entered menopause 10+ years prior to starting MHT.
Additionally, if women older than 65 begin MHT, it may increase their risk of dementia.
Other risks include blood clots, gallbladder disease, and uterine cancer (this is greatly reduced with the use of estrogen-progestin therapy). These risks can be managed by using FDA-approved therapies and following the best practice prescribing guidelines, however, it is important to note that they are further increased by smoking, high blood pressure, or diabetes.
All in all, it is important to remember that…
Just like with any treatment, before beginning MHT, it is imperative that you discuss your complete medical history and any medications you’re taking with your physician to ensure you don’t experience a negative reaction to MHT.
If you do end up using MHT, I recommend checking in with your doctor every three to six months to monitor any side effects that could potentially occur and to determine whether or not you should continue treatment.
What are the benefits of MHT?
Besides reducing hot flashes, bone loss, and vaginal dryness some women have found that it also helps with sleep disturbance, mood swings, and feelings of depression. This may be due to the fact that they’ve experienced less nighttime hot flashes which can affect your quality of sleep and overall mood.
Does MHT cause weight gain?
In short, no, it does not. Weight gain naturally occurs for women between the ages of 45-55 (at an average of 2.2 pounds per year) and has nothing to do with MHT. As we get older our metabolism slows down and we don’t have the capacity to exercise the way we were able to in our youth. Our bodies aren’t able to process as many sweets, bread, pasta, and processed foods either.
On top of that, the hormonal changes that occur during menopause change how our body distributes fat, causing it to form around the belly instead of the hips, buttocks, and thighs. It even converts some of our muscle mass into fat, which is…less than helpful.
The main takeaway here is, MHT does not cause this, and it can actually help prevent fat from settling around the abdomen, which is an added bonus.
What are common side effects of MHT?
Many women experience breast tenderness while using MHT, but this can be resolved by adjusting the dose. For women using cyclin EPT (this includes taking estrogen daily and progestin 10-14 days out of the month) changes in mood, bloating, headaches, and vaginal bleeding can occur. Vaginal bleeding can be avoided by using a continuous EPT, but irregular spotting can still occur in the first few months of treatment. It is essential to let your healthcare provider know about any side effects during the initial stages of MHT. Any side effects you experience can likely be managed by adjusting the dose, delivery method, or both.
Are there any holistic options for managing menopausal symptoms?
Absolutely! If you focus on exercising, eating nutritious foods, getting quality sleep, and managing your stress levels, you can reduce a wide range of menopausal symptoms and even reduce your risk of cardiovascular disease, diabetes, dementia, and osteoporosis.
You can read about this more in depth here.
At the end of the day, whether or not to use MHT is completely up to you. My hope is that you have a more accurate understanding of what it is and how it may benefit your health.
If you’re curious about MHT, you can schedule an appointment with me here, and we can discuss the best options for you and your menopausal journey together.