If under age 60 or within 10 years of menopause Don’t miss out! Do it! The benefits of HRT outweigh risks. I am including many references that support new ideas about this life saving issue so you may share with your doctors if they are concerned about giving you hormone therapy.
I am more convinced than ever that all of us should receive hormone replacement therapy as soon as possible after menopause, if we do not have a contraindication.
We should also stay on hormone replacement therapy as long as possible because this will protect us from getting diseases of aging that kill us women: heart attack, osteoporosis, and Alzheimer’s disease (J Am Col Card 2006, 47(9):1741-53.) JAMA 2002 Aug 288(7):880-887 osteoporosis) Pinkerton JV Climacteric 20(4) 2017:293-295. Pinkerton et al. Menopause 2017;24:728-753.
The hormone replacement therapy should be bioidentical estradiol (transdermal patch or cream or vaginal) with (if you have a uterus) or without natural oral or vaginal progesterone.
Natural or Bioidentical estradiol and natural progesterone do not increase risk of breast cancer. If estrogen is given through the skin as a patch, cream, or gel there is no risk of blood clot or stroke. Estrogen in a pill form should not be used because it does increases risk of stroke and blood clots. Synthetic progestin are not “progesterone” and they cause increase in breast cancer and don’t protect against Alzheimer’s disease. In addition in the WHI study they were giving the Premarin (a conjugated estrogen from pregnant mares) orally, and this is why they observed increases risk of blood clots and stroke.
Fear of breast cancer is the biggest reason that women do not want or get hormones from their physicians. This is because of past studies showing increased risks when using non-bioidentical hormones in particular the Progestins are very toxic to breast tissue and so increase risk of breast cancer.
Rather than fearing breast cancer, we should fear more not being maintained on hormone replacement therapy. Let’s stop this hormone phobia! Women die of heart disease and Alzheimers disease predominantly. These conditions are promoted by lack of hormones.
Overwhelmingly the data shows that starting early within 5-10 years from menopause makes a difference and once you are on hormone replacement stay on them, as long as possible, to protect yourself of multiple aging problems caused by the loss of hormones at menopause.
There is the window of opportunity for hormone replacement: don’t miss your window! After 10 years of no hormones, adding estrogen can be toxic instead of helpful.
Treatment with hormone replacement therapy (HRT) (transdermal estradiol with or without oral natural progesterone) shortly after entering the menopause decreases the risk of getting diseases as follows:
1. Heart Protection
There is 30-50% decrease cardiovascular disease. Grodstein F et al. Women’s Health 2006, Jan-feb 15(1), Lobo RA climacteric 2007; vol 10, sup 2: 21-26. Schierbec L, BMJ 2012; vol345:e6409
The longer on HRT the lower the risk of coronary artery disease. Saltiki et al. Maturitas 2006: 55:51-7)
2. Bone Protection
24% reduction nonvertebral fractures
33% reduction hip fractures. Cauley. J et al. JAMA 2003; 290:1729-1738.
If start early 37% reduction in nonvertebral fractured and 40% reduction in hip and wrist fractures. Torgerson from meta-analysis, DJ et al. BMC musculoskeletal disorders 2001, vol 2: 7
3. Metabolic Syndrome and Diabetes Prevention
HRT prevents fatty liver. Zhu L et al. Diabetes. 2013 62(2):424-34.
HRT decreases risk of Diabetes by 35% (data WHI study) Rossow JE et al JAMA 2002 288(3):321-32. J Gen Int Med 2004:19(7):791-804.
4. Mortality and Cancer Risk
HRT decreases risk of Urinary tract infections by 60%, colon cancer risk 37% , reduces total cancers by 24%. (data WHI study) Rossow JE et al JAMA 2002 288(3):321-32. J Gen Int Med 2004:19(7):791-804.
Decreases breast cancer risk 24%
Decreases overall mortality by 40%
Anderson et al.lancet Oncology 13(5):476-486, 2012.(that means you add a few years to life) with increased quality of life. Hodis HN Mack WJ. J Steroid Biochem Mol Biol. 2014; vol 42: 68-75.
Another Danish studio notes a reduction in mortality of 34% in HRT users Salpeter SR et al. Am J Med 2009; 122:1016-1022.
Even post analysis of the WHI study (27 K women) shows that if estrogen is started early mortality decrease 13-39% JAMA 2017;319(10):927-938.
Further, women who stayed on HRT estradiol alone ( no uterus) from the original Women Health Initiative (WHI) study (2002) had 24% decrease in risk of breast cancer. Of the women who had breast cancer, women who had been on HRT had a 63% risk reduction of dying of their breast cancer versus those on no HRT.
Anderson, The Lancet Oncology 13(5):476-486, 2012
5. Alzheimer’s Disease
Decreases risk of Alzheimer’s disease by 35-60% in various long term studies observing women on HRT for more than 10-16 years.
The risk reduction is best by having higher estradiol levels (around 80 pg/ml which is (low side of normal range for menstruating women).(Cache County studies) Shao H et al Neurology 79(18);2012.
Estrogen decreases risk of Alzheimer’s disease by 30-40% Sherwin B Endocrine reviews 24(2):133-151. Paganini-Hill A Archives of Internal Medicine 1996; 156(19):2213-2217. The highest protection based on Cache County longitudinal studies is found if HRT is started within 5 years of menopause and maintained more than 10 years. Shao H et al Neurology 79(18);2012.
HRT is particularly relevant for women who carry the APOE 4 gene and have a higher risk of Alzheimers disease, they benefit from HRT\’s brain protective effect.. KantarciK et al. J Alzheimers Dis. 2016 May 7;53(2):547-56.
Estrogen/ Estradiol protects the brain by decreasing deposition of beta amyloid, it is an antioxidant, decreases reactive oxygen species, decreases inflammation, helps neurogenesis and interconnectivity of brain cells and in the blood vessles it decrease endothelial damage. Thomas T and Rhodin J Ann of NY Acad of Scie 2000 April; 903 : 501-509.
Reasons to Not Stop Bioidentical Hormone Replacement
Women who stopped their hormone replacement therapy Had 30% increase in mortality risk, 52% increase mortality from stroke, 55% increased risk of hip fracture and protection disappeared within 2 years of stopping HRT. Karin R et al. Menopause 2001;18: 1172-1177.
OK so you missed the window to receive your estrogen replacement
Even if you missed the window of estrogen use you can still do many things to lower your risks: do daily EXERCISE, Mediterranean or ketogenic diet, weight loss, get good sleep, and use other hormones (testosterone for women is great and does not cause breast cancer!), and precision use of supplements based on your unique genetic risk profile.
Be well,
Dr. Beatriz Olson