Betty is a relatively healthy woman in her 70s. She suffers from minor angina. A family history of osteoporosis – plus her own small, slight frame – puts her at risk for osteoporosis. While she hasn’t yet reached that diagnosis, her doctor, who’s been tracking her T-scores, says she’s definitely heading that way. Is Betty a candidate for hormone replacement therapy (HRT)?

Jennifer is 43 years old. Uterine fibroids, with their accompanying heavy bleeding, resulted in Jen having a complete hysterectomy last month. Now she’s starting to have hot flashes… oh, right, she’s going through menopause. Hmmm, menopause… bone loss... Is Jennifer a candidate for HRT?

Diane is 51 years old, and has had just one period in the past year. Her mom was diagnosed with breast cancer at age 60; she recovered. Her grandmother died of complications from a broken hip at age 80. Diane doesn’t live a healthy lifestyle; she’s a heavy smoker, and regular drinker. Her PMS has been tough lately; she’s even had a few hot flashes. Is Diane a candidate for HRT?

Prior to 2002, hormone replacement therapy was the menopausal woman’s best friend. Doctors prescribed it to millions of patients, believing that estrogen (or an estrogen/progestin combination) not only slowed the symptoms of aging, but protected against cardiovascular disease, colorectal cancer, and fractures due to decreased bone density.

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. And, after results of the study were finally released in 2006, HRT use dropped by two-thirds.

Now, doctors are reconsidering HRT. Current thinking is that HRT might be effective and relatively safe for some women, and should be considered for relief of severe menopausal symptoms; or for those at high risk of osteoporosis, without existing cardiac/stroke issues, and with normal risk of breast cancer.

Moreover, HRT might be the best choice for women who’ve gone the bisphosphonate route to curtail bone loss; and either couldn’t stomach the medicine (literally!), or for whom the drugs didn’t work.

Why the change in thinking? Bone density decreases most rapidly during the first 2 years of full menopause, then slows considerably thereafter. And, studies show that HRT builds bone mass very effectively for about 3 years, then seems to lose its effectiveness.

In addition, it’s been shown that HRT, taken for just 2 to 3 years, carries considerably less risk than when it’s taken for long periods of time.

Thus, for women experiencing severe menopausal symptoms; or at significantly increased risk of osteoporosis; and without underlying risks that would prevent taking it, a low dose of HRT for the first 2 to 3 years after menopause starts* would seem to be the safest, most effective way to lower osteoporosis risk.