The Truth About Hormone Therapy: Separating Fact From Fiction
Perimenopause and menopause can be a challenging time for many women. Whether it’s hot flashes, mood swings or something in between, the bounty of hormonal changes can be difficult to navigate. Enter hormone therapy. It’s on most of our radars during this stage of life, but with conflicting information and misinformation about its safety and effectiveness, it can be hard to know what to believe. In this post, I’ll separate fact from fiction and explore the real truth about hormone therapy as I understand it.
Before rushing into any prescription therapy as a primary solution, including hormones, it’s important that you explore natural options that will heal your body first. Lifestyle modifications like regular physical activity, a balanced diet rich in fruits, vegetables and lean proteins can all help to manage symptoms and tilt the scale toward hormonal balance. Once lifestyle has been taken into account and if symptoms remain, hormone therapy is considered a safe and effective treatment for perimenopause and menopause and can help to work preventatively against other more serious health conditions as we age.
Before diving into the facts, it’s important to define what hormone therapy is. Hormone therapy, or hormone replacement therapy (HRT) as it’s also known, involves taking prescribed medications, usually estrogen and progesterone, to replace the hormones that naturally decrease during perimenopause and menopause.
There are two main types of prescribed hormone therapy: estrogen-only therapy (ET) and combination therapy (CT), which includes both estrogen and progesterone. Both types of hormone therapy are available in bioidentical and non-bioidentical forms (more on that to follow) and both types can be taken via different methods such as pills, patches, creams, or gels.
Bioidentical and non-bioidentical hormones differ primarily in their structure and origin. Both are synthesized in labs but bioidentical hormones are chemically identical to the hormones produced by your body. Their identical structure allows them to bind perfectly with your body's hormone receptors, leading to a more seamless response.
On the other hand, non-bioidentical hormones, often referred to as synthetic hormones, have a different molecular structure from the hormones produced by your body. They are derived from sources such as pregnant mare's urine and are not identical to human hormones. Consequently, their interaction with your body's hormone receptors can be less perfect but still effective; however, they may lead to side effects or less predictable outcomes.
Compounded hormone therapy is another option often discussed in the context of hormone replacement therapy. These are custom-blended hormones created by a pharmacist based on a healthcare professional's orders. While some claim that compounded hormones are safer or more effective than standard hormone therapy, it's important to understand that these aren't Health Canada or FDA-approved. This means they haven't been subjected to the same rigorous safety and efficacy testing as standard hormone therapy medications but are a good option for patients who need non-standardized doses or who are unable to swallow pills, for example.
Some people believe that “natural” alternatives to hormone therapy such as certain herbal supplements are safer or more effective however, there is little scientific evidence to support these claims, and some alternative therapies can even be harmful. For example, black cohosh, a popular herbal supplement for menopause symptoms, has been linked to liver damage. It’s always best to consult with your healthcare practitioner before taking any supplemental protocol.
Hormone therapy is often used as a treatment for many of the symptoms associated with menopause, like hot flashes, night sweats and vaginal dryness, by replacing the hormones that a woman's body ceases to create after menopause. Hormone therapy can also be used by women in perimenopause as a preventative measure against several conditions that become more prevalent after menopause, including heart disease, cardiovascular disease, and osteoporosis caused by a decline in estrogen. The benefits and risks of hormone therapy vary depending on factors such as age, health history, and the type of therapy used.
So why did it get such a bad rap?
While it can be highly effective, hormone therapy is not suitable for everyone and there are several reasons why a woman of menopausal age might not qualify to take it. One significant reason could be the associated health risks. Studies have shown that hormone therapy could potentially lead to an increase in the risk of heart diseases, stroke, blood clots, and certain types of cancer. Additionally, women with specific health conditions or personal histories, such as those who have had breast cancer, liver disease, or a history of blood clots, may be advised against hormone therapy. Hormone therapy can also come with side effects which range from bloating and mood swings to breast tenderness and nausea. And finally, some women may simply prefer to manage their menopausal symptoms with lifestyle changes only or non-hormonal treatments to avoid introducing foreign hormones into their bodies.
And then there is the breast cancer scare…
The common misconception about hormone therapy causing breast cancer is the result of a study conducted in the early 2000’s indicating risk however this study has since been proven to be flawed and more recent research has all but overturned the results. While there may be a slight increase in breast cancer risk with long-term use, the overall risk is relatively small and typically in those genetically susceptible to estrogen receptor type cancers. Additionally, the risk of breast cancer returns to normal once hormone therapy is stopped.
The duration you can use hormone therapy can vary greatly depending on an individual's personal health needs and circumstances. For some, hormone therapy may be used for a few years, while others may need it for longer periods to manage persistent menopausal symptoms or to mitigate health risks related to the decline of estrogen levels after menopause. The latest scientific evidence is showing that hormone therapy can be used indefinitely provided the patient is tolerating it well. Regular follow-ups with your healthcare provider are essential to assess the ongoing need plus any potential side effects keeping in mind that each person's experience will be unique and should be managed with personalized medical advice.
If you are interested in hormone replacement therapy, it's crucial to have an open and thorough discussion with your doctor. This conversation should include personal and family medical history, current health status, and the symptoms or health risks you’re hoping to alleviate. Every woman should ask about the potential benefits and risks of hormone therapy and the different types of therapy available. You should also inquire about alternative therapies and lifestyle changes that could help with symptoms. Understand that regular follow-up visits are essential for monitoring your response to the treatment and adjusting the therapy as needed.
Overall, hormone therapy can be a safe and effective treatment for the treatment of symptoms of perimenopause and menopause for the majority of women. Always work with your healthcare provider to determine the best course of treatment based on your individual health and needs. Don’t be swayed by myths or misinformation when it comes to hormone therapy – instead, seek out reliable sources of information and ask your healthcare provider questions. With the right approach, hormone therapy can help you feel your best during the transition into menopause and protect your health for years to come.
