Hormone Replacement Therapy – What are the REAL risks?

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Before we dive into one of the most hotly debated topics related to hormone therapy, its important to understand – what exactly is HRT?  During the menopausal transition, the production of two female hormones (estrogen and progesterone) begin to fluctuate and eventually decline.  HRT is the act of supplementing these hormones (one or both) to balance out what the body is no longer producing?

Is HRT safe?  Well, that is certainly a very important question and the answer is YES, for most women.  Unfortunately, fear of risk (and an undereducated clinical workforce) keeps most women from being offered or using hormone replacement therapy.  So many women feel they need to “tough it out” or just don’t know who to ask for help – so they don’t ask at all.

Some women may remember back in 2002, when the results of a massive study – the Women’s Health Initiative (WHI) — suggested that HRT usage led to a higher risk of breast cancer, heart disease, and blood clots. This set off a media uproar that led many women and doctors to abandon HRT practically overnight.  Unfortunately, these results were largely misinterpreted, since most of the women in the study were already in a high-risk category in terms of age and health.  In fact, subsequent follow-up studies and clinical trials have been conducted showing that HRT can improve long-term health outcomes, including decreasing heart disease, risk of dementia and osteoporosis and in some cases, breast cancer.

So, who is appropriate for HRT and who is not?  Well, if you are less than 10 years since your final period, under the age of 60, do not have breast or uterine cancer, a history of blood clots, liver disease or a 10-year cardiac risk >10% then you are likely appropriate to be considered for treatment.  For women with a strong family history of breast cancer and other major cardiovascular risk factors, a more in-depth risk and benefit conversation with a menopause practitioner is warranted.

One of the most common questions regarding HRT risk that we get asked all the time is – doesn’t hormone replacement therapy cause breast cancer? The truth is that all women who have breasts are at risk of breast cancer. The real question is how does hormone therapy actually impact risk?  Unfortunately, the statistics for breast cancer in the United States are eye opening – 1 in every 8 women will get breast cancer in their lifetime.  And women who take both estrogen and progesterone as part of their HRT regimen do take on some ADDED measurable risk.  However, this additional risk is actually quite small – really only an additional 6 cases in 1000 women over 10 years.  To put that in perspective, this increase is less than drinking more than 7 alcoholic beverages per week, of being overweight, or being inactive (not exercising regularly).  If women are terrified of the added risk of breast cancer when taking hormone therapy, then they should be terrified of alcohol too. 

If you are considering hormone replacement therapy, having a firm grasp of your own medical history, as well as your extended family history will help your menopause practitioner get the most accurate understanding of your personal risk assessment.  Before your appointment, you may also want to collect your most recent breast imaging studies and check to see if your breast density has been reported.

Feeling more confident about the risks of HRT?  Ready to see if HRT is right for you?  Let us help you understand your personal risk, and get you on the path to hormonal health optimization that will have you feeling your best now and, in the years to come! Contact us for a Free Phone Consult.





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