04 Jan Is Hormone Replacement Therapy Safe?
Hormone replacement therapy can effectively control and eliminate symptoms related to hormone depletion such as hot flashes, headaches, dry skin, night sweats, fatigue, vaginal dryness, mood fluctuations and sleep disturbances. Albeit some of these general symptoms can arise from other underlying issues, an evaluation of hormone levels should be a high priority. There have been some publications in the recent past that created a false narrative with a generalized statement like “hormone replacement therapy cause blood clots and/or cancer”.
To start the conversation with hormone replacement therapy, it should begin with the Women’s Health Initiative (WHI) published in 2002. They found an increased risk of breast cancer and cardiovascular events. It is important to understand the findings and how they are reported since numbers can be deceiving. For instance, WHI found a 29% increase in cardiovascular disease by way of relative risk but as an absolute risk the increased risk as compared to placebo was 0.07% (Clark, 2006). What that means is no difference in risk vs placebo in a study that drastically changed the prescribing of hormone replacement therapy during its time. These statistics repeatedly were skewed in a similar fashion with other detrimental comorbidities.
On the contrary to WHI, there are countless studies promoting the use of hormone therapy and its benefit. A study published in 2013 after WHI followed declining levels of estrogen therapy in women, they estimated between 18,601-91,610 postmenopausal women died prematurely because estrogen therapy was avoided (Sarrel, 2013). Another study pooled results from 27 trials with over 16,000 women with a mean age of 55 and what they found a mortality relative risk of 0.72. This means there was a 28% reduction in mortality in women receiving hormone therapy (Salpeter, 2009). The article by L’Hermite discusses advantages of bio-identical hormones over conventional therapy as well as different routes of administration (L’Hermite, 2017).
So where do we go from here? Do I feel that every woman going through menopause or having hormone depletion related symptoms should be on bio-identical hormone replacement therapy? The answer is probably not. However, if clinical labs and physical presentation of a particular patient show hormone supplementation would be beneficial for a patient for quality of life and health. If you are questioning safety, look at the studies for yourself. It is important to be educated on what you are putting into your body. These studies have not only shown safety but also increased quality of life. The key that gets lost when having this discussion is appropriate dosing and monitoring. Providers perform labs to ensure appropriate blood serum levels of hormones and give the minimum dose to achieve the optimal response. You would not want to take three times the strength of your recommended dose of blood pressure medication so the same would be for hormone therapy no matter how it made you feel. This in itself would warrant increased risk of unwanted side effects.
Clark J. H. (2006). A critique of Women’s Health Initiative Studies (2002-2006). Nuclear receptor signaling, 4, e023. doi:10.1621/nrs.04023
L’Hermite, M. (2017). Bioidentical menopausal hormone therapy: registered hormones (non-oral estradiol+/- progesterone) are optimal. Climacteric. 20(4): 331-338. doi: 10.1080/13697137.2017.1291607
Salpeter, S.R., Cheng, J., Thabane, L., Buckley, N.S. & Salpeter, E.E. Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women. The American Journal of Medicine, 122(11), 1016 – 1022.
Sarrel, P. M., Njike, V. Y., Vinante, V., & Katz, D. L. (2013). The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years. American Journal of Public Health, 103(9), 1583–1588. doi:10.2105/AJPH.2013.301295