The origin story of HRT or Menopausal Hormone Therapy (MHT) as it is now more commonly referred to, goes a long way to explaining why the most common question I get from women on the topic is IS IT SAFE?
The short answer is for most women HRT through menopause is not only safe but incredibly helpful in managing symptoms of the menopausal transition. It can also support other factors of long term health as well.
This will of course require a discussion with a prescribing specialist but I hope to give you some information to help guide that discussion if it’s one you wish to have.
LOOK AT THE HISTORY
The first significant use of HRT though menopause was around the 1940’s when estrogen was isolated from pregnant horse urine and used to make a product known and marketed as Premarin. This alongside a synthetic form of progesterone were the original HRT products on the market and it was used widely for a number of years.
There were positive benefits seen on markers of bone density, but some concerns were raised when observational data showed an increased risk of cardiovascular risk in some women using it. So the biggest scientific study to date on the topic was launched.
This was called the Women’s Health Initiative. They enrolled older postmenopausal women, the ones at higher risk of cardiovascular events, and the preliminary finds shook the world of HRT prescribing from that day forward.
Cardiovascular events did increase in the first year of the study but then dropped off and some increase in breast cancer risk was also seen. Despite the evidence of some positive effects on bone health, HRT prescriptions plummeted by 79% and prescribers have been at odds on the topic ever since.
Further fueling confusion, compounding pharmacies started offering bio-identical hormones. These were less regulated dose wise and not supported or prescribed by general practitioners.
Fast forward to 2020 ish and while a LOT has changed in the research and how HRT is prescribed, little has changed in the confusion on the topic itself.
PROBLEMS WITH THE OLD HRT
- Not all estrogens are the same:
It was equine estrogens rather than human identical estrogens. Various ones of these estrogens are now known to significantly increase inflammatory markers in the body and drive processes that could have contributed to some of the risk factors seen.
It was an oral dose which is less consistently absorbed due to gut variability and may require larger doses to be effective.
- Not all progesterones are the same:
These estrogens were prescribed in combination with synthetic progesterone which has none of the beneficial effects of natural progesterone and a lot of negative effects. Including increased blood clot risk and increased breast cancer risk.
- The age of the women used confounds the evidence:
It was a study done on women well past the menopause transition looking at specific outcomes – namely cardiovascular risk. It also did not factor in any of the positive effects. Which raises questions of how does this actually correlate with younger age women.
HOW IS THE NEW HRT DIFFERENT
Equine estrogens are no longer used, instead regulated doses of body-identical hormone are used. These have the same chemical structure as the hormone we make ourselves. These don’t have the same pro-inflammatory factor that some estrogen-like molecules have.
It is most commonly prescribed as a transdermal patch. This absorbs straight into the bloodstream at a more consistent rate and can be used at a lower dose than oral prescriptions.
This does not carry an increased risk of CVD events and there is no solid research that consistently shows an increased risk in breast cancer. If any it is very small, at a similar level to a low level of alcohol intake or a sedentary lifestyle.
It is often given in combination with oral micronized progesterone which is body-identical progesterone and carries all of the beneficial effects on mood, sleep, brain health that our natural progesterone has.
Body-identical progesterone does not increase risk of breast cancer and some research suggests it may even reduce risk.
A MOVING SCIENCE
- Science moves a lot faster than medicine and prescribing.
This can create a gap, which is what we are seeing with the confusion and seemingly conflicting advice on HRT depending on who you talk to. The science is there to support its use, but the advice and prescribing practices have not all caught up yet.
- With HRT, the science and evidence has moved but old beliefs and fears remain.
Research suggests that GP’s are not immune to this. A significant portion of prescribers suggest that personal biases, beliefs about menopause, and lack of understanding stopped them from offering this treatment to women in their clinics.
This means that where once a large number of women were prescribed a treatment that may have been a negative for their health, we now have a generation of women who are not being offered a treatment that could be hugely beneficial, due to fears from the past.
CONSOLIDATING IT ALL
As it stands, with the current options for body-identical HRT, this is a treatment option that in a large number of cases is likely safe, and potentially hugely helpful for managing some of the life impacting symptoms of menopause.
There are also many women who don’t have troublesome symptoms who may do perfectly well without it, and this is just fine too.
Menopause is not a disease or a condition, it is simply a transition where some people may need support where others don’t.
Because there are gaps in the prescribing confidence amongst general practitioners, you may find that you get the best advice and options from someone who specializes in women’s hormones. There are a number of hormone clinics and menopause specialists around which you can go to without referral.
You can’t hormone treatment away a diet and lifestyle that doesn’t support your hormone health. HRT will work best as an add on treatment when you address other factors that support balance in your life. Nutrition shifts to compliment the changing hormones, movement habits that support the body and managing stress.
These are things we work on with women in the Body Reset program and see consistently exceptional results. You can see if this is a good option for you by taking our free quiz. But the real takeaway here is don’t be afraid to ask questions, if you feel this something that could help you.