Is hormone replacement therapy for menopause safe?

As a full-time OBGYN and woman in menopause, Dr. Amy French, a board-certified OBGYN affiliated with Sharp Grossmont Hospital, jokes that she talks about menopause all day, every day. Whether with patients or friends, Dr. French never shies away from the topic many would like to avoid.

However, every woman of a certain age will experience menopause, she says. This natural, biological process marks the end of their menstrual cycles, occurring, on average, when a woman is around 51 years old. However, menopausal symptoms can start a few years earlier, and each person’s experience will be unique.

Some common symptoms of menopause include:

• Bleeding irregularities

• Hot flashes and night sweats

• Brain fog and forgetfulness

• Anxiety, irritability and depression

• Dry skin and eyes

• Hair changes

• Poor sleep

• Weight gain

• Dry vagina and painful sex

• Increased urinary tract infections (UTIs)

• Loss of libido and change in orgasm

• Painful joints

• Osteopenia and osteoporosis

“The symptoms of menopause can be uncomfortable, concerning and really affect your quality of life,” Dr. French says. “There is definitely no one way to approach your symptoms, and what works for you may be totally different than your friends.”

There is also an abundance of misinformation surrounding this time in a woman’s life and a hunger for accurate information. “I think this is the first generation of women going through menopause who want to talk more about it and want more information and validation of what is happening,” Dr. French says.

From myths to treatment that works

The need for accurate information is why Dr. French finds herself in daily conversations, correcting mistruths and sharing facts. One myth about menopause that has affected the choice women make in treating their symptoms has to do with hormone replacement therapy (HRT). HRT involves replacing a woman’s hormones that have diminished as she ages.

“In 2002, there was a large study that changed everything surrounding the treatment of menopause,” Dr. French explains. “The study was stopped early because there was concern that the hormones being studied led to an increase in breast cancer and cardiovascular risks. It made all of the front pages; and soon after, 50% of all women stopped hormones and many doctors stopped prescribing it.”

However, it was later determined that the women in the study were older — with an average age of 63 — smoked more and were more obese than the average woman going through menopause. “This study did not represent the average woman starting hormone therapy,” Dr. French says.

What followed over the next two decades was confusion, a significant division between women and their doctors, and a variety of treatments that didn’t work. Some therapies were even found to be dangerous.

Advancements in treatments — and understanding

Women and their doctors, Dr. French reports, now have a better understanding of safe and effective treatments for menopause, including FDA-approved hormone therapy. Estradiol is the predominant form of estrogen in women’s bodies and replacing it can help with menopause symptoms, including hot flashes; night sweats; and mood, sleep and bone health problems.

Bio-identical estrogen can be applied using a transdermal (through the skin) method, such as with an estradiol patch, gel or spray. A woman can also receive estrogen through a ring inserted in the vagina or a pill taken by mouth. There are a variety of dosing options, which can be adjusted to an individual’s symptoms.

If a woman has a uterus, replacing progesterone is necessary because estrogen taken alone can stimulate endometrial cancer in the uterus. Progesterone can be taken in the form of a capsule, IUD or a CombiPatch, which has estrogen and progesterone combined. While oral progesterone doesn’t treat menopause symptoms, it often improves sleep.

Other benefits of menopause hormone therapy include:

• Slowed bone loss

• Significantly decreased risk of Type 2 diabetes

• Slight improvement to symptoms of depression if used in perimenopause

• Significantly reduced risk of death by all causes

Timing of HRT is key

Starting hormone therapy before age 60 — earlier if a woman goes through menopause before 50 — is essential to reducing any related cardiovascular risk. But that’s not what patients are usually concerned about, Dr. French reports.

“The biggest concern of my patients when talking about hormone therapy is breast cancer,” she says. “And to be honest, we still have a long way to go in studying this. However, it has been found that estrogen in women who don’t have a uterus slightly decreases the risk of breast cancer, while estrogen plus progesterone slightly increases the risk.”

The small but statistically significant increase in the incidence of breast cancer, Dr. French says, doesn’t usually occur until women have been on the medication for five or more years. Additionally, hormone therapy can make breasts denser, which can potentially obscure cancer during mammograms.

Regarding other myths surrounding HRT:

• There is no increased risk of dementia if hormone therapy is started at the time of menopause.

• Transdermal estrogen does not increase the risk of blood clots.

• Hormone therapy does not affect a person’s weight, though it does seem to slow weight gain.

“Treating menopause symptoms may also allow a woman in menopause to exercise more comfortably,” Dr. French says. “And not having that stress-eating response may help you eat with more intention and maintain a healthy weight.”

Seeking care for symptoms

Talk with your doctor if you are experiencing the signs of menopause. Along with hormone therapy, there are other effective treatments, including antidepressants, nerve medications and a nonhormonal medicine for hot flashes that is safe for women with breast cancer.

Women who have irregular bleeding; liver disease, such as cirrhosis or hepatitis; or who have had breast cancer, heart attack, stroke, a blood clot in the legs or lungs, or an inherited risk of blood clots are generally advised not to use hormone therapy.

“Whether you have terrible symptoms or none, and whether you take hormones or not, the key to staying healthy and enjoying later life seems to be staying physically active and engaged mentally and seeing friends often,” says Dr. French. “I’ve had the pleasure of caring for many women into their 70s and 80s who are still enjoying life. The common denominator is always maintaining physical activity, interests in travel or hobbies, and friendships.”

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