We’ve all heard conflicting information about hormone therapy (HT). You may have a friend who experienced weight gain after starting hormones or an aunt who got breast cancer after years of hormones. On the other hand, your best friend raves about how great she feels on HT. You’re conflicted - your night sweats have prevented a good night’s sleep for years so you may be wondering- could HT be worth it? Let’s take a look at the facts of hormone therapy and bust some of the most common myths!
1. Does HT cause weight gain?
HT does not make you gain weight. In fact, HT can help to redistribute fat away from the midsection, since this type of weight gain can be due to hormone changes in menopause. Some studies find that women who are on HT respond better to exercise interventions to help with weight loss. Unfortunately, weight gain is a natural part of aging due to increased hunger, decline in metabolism and reduced physical activity. This is why lifestyle modifications are extremely important in this stage of life.
2. Does HT cause breast cancer?
All women have a baseline risk of breast cancer - in fact, 1 in 8 women will develop breast cancer in their lifetime. Your own personal lifestyle habits, history and family history play into your risk. Research has found that women who only use estrogen HT (appropriate for women who have had a hysterectomy) or vaginal-only estrogen are not at any increased risk of breast cancer. Women who use HT containing both estrogen and progestins (synthetic progesterone) are at slightly increased risk for breast cancer. That increased risk is about 1/1000 which is equivalent to the risk as if you are overweight or have moderate alcohol use. Good news though - more recent data is showing that bioidentical micronized progesterone, natural progesterone made from plants, does not increase the risk of breast cancer. Regardless of the type of HT you decide to use, once stopping the HT, your risk will return to baseline.
3. Does HT increase the risk of cardiovascular disease?
If started before age 60 or within 10 years of your last period, HT can actually prevent and slow down the progression of atherosclerosis (hardening and narrowing of the blood vessels). Your lifestyle, medical history, and family history all contribute to your personal cardiovascular risk. Additionally, menopause symptoms such as hot flashes, night sweats, sleep disturbance, and depression have all been found to increase your risk of cardiovascular disease.
4. Are there over-the-counter treatments that work better than HT?
The Menopause Society does not endorse any supplements to treat hot flashes or night sweats due to limited data regarding the effectiveness and safety of supplements. HT remains the gold standard to treat many menopause symptoms and to prevent bone loss and fracture.
5. Is HT unnatural?
Menopause is a natural stage of life. Does that mean we have to grit our teeth and suffer through? No! By that logic, we should be suffering through all types of “natural” medical conditions without treatment. The good news is that there are many safe and effective options for menopause treatment! There are synthetic forms of hormones that we can use, which are the same hormones that are used in birth control. Even better, most of the hormones used today in FDA-approved hormone therapy prescriptions are natural, derived from plants and bio identical to the hormones already found in our body. These forms of HT are thought to be better tolerated and associated with less risk.
6. Can I start HT if I’m experiencing symptoms but I’m not yet menopausal?
Absolutely! This stage is what we call the perimenopause stage, when your hormones start to fluctuate and symptoms arise, but you are still having either a regular or irregular menstrual cycle. The average age of perimenopause is 45-55 years old. If you would like to address your symptoms during this time, HT can help level your hormone changes to get you feeling like yourself again.
7. Do I have to stop HT after a certain amount of time?
There is no set age or length of time that determines your “expiration date” for HT. The guideline for HT, as with most medications, is the lowest effective dose needed for symptom relief. This is because the risk-benefit profile changes as you age, which is why your provider will request regular checkups to review your medical history, any changes that could increase your risk and give recommendations for safer alternatives based on the most current medical literature. Additionally, vaginal-only HT is not absorbed into the bloodstream at meaningful levels and can safely be continued for decades.
8. Are there other benefits to HT besides symptom relief?
Yes! HT is approved for the prevention of osteoporosis and is more effective than over-the-counter supplements. If started within the safe window, HT can also help to prevent cardiovascular disease and Type 2 diabetes later in life. In women who have a history of mood disorders, such as anxiety or depression, HT can help to prevent exacerbations during perimenopause and early in menopause. Currently, the medical literature is unclear if early initiation of HT can assist in preventing Alzheimer’s.