HRT – Should You Consider It?

PJ Hamel Health Guide
  • Prempro.  Back in 2002, up to 6 million American women were taking this hormone replacement therapy (HRT) drug, convinced (as were their doctors) that it worked miracles against the ravages of menopause: hot flashes, mood swings, bone loss.

    Prempro (and its sister drugs) were supposed to put the spring back in your step, verve in your sex life, even iron the wrinkles from your face.

    HRT was the menopausal woman’s best friend.

    Until suddenly it became her worst enemy.

    Women were prescribed HRT beginning over a half-century ago, as doctors believed the estrogen/progestin combination not only slowed the symptoms of aging, but protected against cardiovascular disease, colorectal cancer, and bone fractures.

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    At the height of its popularity, an estimated 15 million women were happily taking HRT. And did it help?

    Well, yes… and no. HRT did indeed help menopausal and post-menopausal women look better and feel healthier. It lowered their risk for colorectal cancer; hip fracture risk was reduced by 40%, and other fractures by 30%. It also quelled the hot flashes and other miserable side effects of menopause.

    But the massive Women’s Health Initiative (WHI) study, completed in 2002, showed that HRT actually increased a woman’s risk of heart attack, stroke, blood clots, and breast cancer.

    So HRT use dropped by about two-thirds in 2007, following the release of the WHI study’s results in December, 2006.

    Now, the pendulum may be swinging back again – at least a tiny bit. As time passes and data from the WHI continues to accumulate, it appears that using HRT to get through the toughest part of menopause may not pose as much of a risk as was first thought.

    A study released earlier this year indicates that women can greatly reduce their risk of all of HRT’s negative side effects – including breast cancer – by taking it for less than 5 years.

    Michelle Warren, medical director of the Center for Menopause, Hormonal Disorders and Women's Health at Columbia University, said in an interview in "O" magazine last spring, "If you look at the science carefully enough, the two-to-five-year period that most women need HRT to get through this transition is relatively safe."

    Bone density decreases by about 3% to 5% each year in the 2 years after menopause. After that, the decrease slows considerably. So should women go back to considering HRT as a way to cushion menopause’s short-term negative effect on our bones?

    Well, not all women. If you’re at known risk for breast cancer or cardiovascular issues, due to family history or previous experience with these conditions, increasing your already existing risk with HRT isn’t a good idea.

    And if you’re not suffering debilitating menopausal symptoms – hot flashes that won’t stop, chronic insomnia, mood swings that make it hard to function – you might just try to tough it out without HRT. After all, though its negative side effects are reduced, they still exist.

    So when might HRT be appropriate?

    Doctors are now in agreement that HRT is worth considering in two different populations:

  • •Women hit particularly hard by menopause, where the side effects are so devastating that they affect quality of life and ability to function;

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    •Women with severe osteoporosis, for whom bisphosphonates and lifestyle changes haven’t worked.

    In both of these cases, the lowest effective dose of HRT, for the shortest period of time, presents the best balance between risk and benefit.

    We’ll never go back to the days of thinking HRT could safely ensure us long years of increased vitality, post-menopause.

    But we’ve also moved beyond thinking of it as evil.

    Are you struggling with menopause? Ask your doctor about HRT. While you wouldn’t consider it simply to improve bone health, using it for severe hot flashes and insomnia does have a known benefit: a reduced risk of fractures.

    And that’s one side effect we can happily live with.

Published On: January 09, 2010