Your guide to understanding hormonal replacement therapy (HRT) for menopause
Ten years ago, if you had told me that I’d become the founder of a menopause company, I wouldn’t have believed you. But as a scientist whose interests took me deeper and deeper into the women’s health space, I came to realize that despite affecting more than half the population, menopause is a health transition that’s rife with misinformation, especially concerning effective treatments like hormone replacement therapy (HRT). All women have the right to base their health decisions on clear, factual information, so keep reading for a scientist’s perspective on this treatment.
What is menopause?
Estrogen plays a key role in everything aspect of how our bodies function. When our estrogen levels start to fall, we not only experience the physical discomfort of a changing equilibrium, but our actual health is compromised, too. The short-term symptoms include huge disruptions like hot flashes, night sweats, sleeplessness and anxiety, and the long-term symptoms can affect our heart, brain, bones, metabolic health, libido and more.
The technical definition of “menopause” is the moment in time when your estrogen has dropped so low that you haven’t had your period in a year. But the term is generally defined more loosely as the entirety of the transition, usually occurring somewhere between age 45 and 56. “Perimenopause” is a term you might have heard as well; it’s typically used to describe the earlier stages of menopause.
What’s important to know is that you can be in perimenopause or menopause and not experience hot flashes (also called “vasomotor symptoms”). There are dozens of symptoms connected to this transition; read more about them here. That’s why it’s incredibly important not to wait to get treatment.
What is hormone replacement therapy (HRT)?
Hormone replacement therapy (HRT) is a prescription treatment that can mitigate the effects of low estrogen by literally just doing what its name suggests—replacing the estrogen that your body is no longer producing (and doing so in levels that are lower than what you’d get in a typical birth control pill). Studies show that HRT is 80% effective at alleviating short-term menopause symptoms (including hot flashes, night sweats, low libido, weight gain, sleep issues, anxiety and more), and the data on long-term health, such as reducing your risk of Alzheimer’s by up to 30%, is equally promising.
The core component of hormone replacement therapy usually consists of estrogen, delivered as a patch or in a pill. Currently, the patch is believed to be the best method, as it’s less likely to have any negative cardiovascular effects (which are very rare). If you still have a uterus, you’ll also be prescribed a progesterone pill, which helps prevent cell buildup in the uterine lining. It bears repeating that the amount of estrogen in HRT is less than what you’d encounter in a birth control pill.
Your doctor can help you determine your eligibility for hormone therapy based on your symptoms and some other key questions about your medical history. Importantly, more and more evidence is pointing to the fact that we may be beginning hormone therapy too late. Often, women will turn to it when they start having hot flashes and night sweats, but it’s extremely effective for a host of symptoms that also start sooner—among them, anxiety, depression, sleeplessness, lack of libido, and more. The earlier you start HRT, the bigger the benefits are for long-term health, too. Studies show, for instance, that women who begin HRT early have protection from heart disease and dementia.
The controversy surrounding HRT
Over 20 years ago, a study called the Women’s Health Initiative presented data around HRT in such a way that it could be misinterpreted to suggest a slight increase in breast cancer risk among women taking HRT. That interpretation has been debunked by nearly every medical organization, including the North American Menopause Society. But myths die hard, and we’re still undoing a lot of the damage that was done.
What we now know is that the potential risks that study suggested weren’t just relatively small, they were also primarily concerning women who began hormone therapy aged over 60. Those who started within 10 years of menopause had a different risk profile altogether. In addition, an 18-year follow-up on the WHI participants found that those who took hormones had a lower risk of dying than those who did not take them. Specifically, the researchers noted that HRT “was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years.”
What else to know
There are three exceptions to the above: If you’ve had breast cancer, have a high risk of getting it, or have a family history of blood clots, you may want to consider other treatment paths. HRT remains the gold standard, but newer prescription treatments like Veozah or over-the-counter options like Femistry have promising research behind them.
For some women, particularly those in early stages of menopause, making diet and lifestyle changes like reducing sugar and alcohol, increasing exercise, sleeping 7-9 hours, and more can also help. Importantly, nearly all women can take vaginal estrogen, even most breast cancer survivors, to treat many of the vaginal and urogenital impacts of menopause which range from frequent UTIs to painful sex.
Always consult your doctor to help you assess your risk. Digital health menopause companies like Evernow, which I founded in 2019, can help you not just start a treatment path but also continue to get the answers and support you deserve at every step of your journey.
Key takeaways
The conversation about menopause and hormone therapy hasn’t been given its due, but our generation is in a position to change that. The best thing any woman in her 40s and above can do is to connect with a healthcare provider who’s trained in menopause treatment.
They can help assess symptoms and put you on the path to treatment. Menopause isn’t something you should have to white knuckle. Treatments like HRT were developed so we can continue to feel our best for years to come, and we owe it to ourselves to follow the research and make the best decisions for our unique circumstances.
