The use of hormone replacement therapy, commonly referred to as HRT, has been a topic for debate amongst healthcare professionals for many years. Some tout its benefits, regarding the treatment as somewhat a kin to a miracle drug, while others warn about its risk in regards to cancer development and other concerns. As a patient, it can be difficult to decide what is best even with the direction of a trusted physician; and for practitioners it can even be hard to decide who would truly benefit from an HRT plan versus who would benefit from an alternative. Understanding the use, benefits, and risks requires looking at the research, which thankfully has become more clear in recent years.
HRT can be recommended to both men and women at various stages of life. Most commonly testosterone is recommended to men with signs of low production, including low sex drive, low muscle tone, depressed mood, etc, and/or a measurable deficiency on lab work with minimal controversy. For women however, it’s a bit more involved resulting in the current and long-held controversy. For one, multiple hormones need to be considered in women. Many receive a combination of estrogen, progesterone, and testosterone; while others may just take one hormone; it all depends on symptomatology, lab work, and medical history. Most commonly, HRT in women is used for symptoms of perimenopause including night sweats, mood swings, heavy periods, weight gain, dry skin, insomnia etc, but can be used for menstrual related issues, and in some cases infertility. For the purposes here, focusing on the use of HRT in women for perimenopause/menopause will be more relevant.
In 2002, the Women’s Health Initiative (WHI) study presented results that sparked the discussion on the potential risks of hormone replacement therapy. They stated HRT was linked to an increased risk of breast cancer, heart attacks, blood clots, and strokes (1) and received a lot of media attention. For many, this is still the accepted fear, however with closer evaluation this study was found to be incredibly misleading. In reality, the benefits and risks of HRT use depends heavily on the age, medical history, the hormone type used, whether its given alone or in combination, the administration route, and the age of menopause.
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After much review by medical researchers, HRT is now considered highly beneficial when given to symptomatic women who are under the age of sixty and/or who are within ten years of menopause onset (2). In these women, HRT was shown to significantly reduce all-cause mortality and cardiovascular disease (CVD), even when typical CVD prevention strategies failed (3). In addition, it improves the symptoms related to menopausal estrogen deficiency such as hot flashes, night sweats, and vaginal dryness.
That being said, hormone replacement therapy is not right for all women. For example, unopposed estrogen can increase the risk of uterine and endometrial cancers. Therefore, it is not recommended that women with an intact uterus receive estrogen-only HRT and instead receive estrogen and progesterone in combination. On the other hand, women who have a family or personal history of breast cancer may need to be wary of receiving HRT that is estrogen and progesterone in combination, as this was found to slightly increase risk compared to estrogen-only HRT (2). Determining what is best for each individual has to take into account all of these factors for a safe and effective treatment to be established.
At AYUMETRIX, the hope is that providers and patients feel supported in their decision to use or not use hormone replacement therapy and how they use it. Lab values can be vital in determining the cause of symptoms and aid in the appropriate dosing of these hormones. This helps to ensure their use is safe, effective, and appropriate for each patient’s unique situation. For more information please visit www.ayumetrix.com or click the link below for additional information regarding available testing.
References:
1. Writing Group for the Women’s Health Initiative Investigators. 2002. Risks and benefits of estrogen plus progestin in healthy post-menopausal women. JAMA. 288(3): 321-333.
2. Cagnacci, Angelo and Venier, Martina. 2019. The controversial history of hormone replacement therapy. Medicina. 55(9): 602.
3. Hodis, Howard N and Mack, Wendy J. 2022. Monopausal hormone replacement therapy and reduction of all-cause mortality and cardiovascular disease: it is about time and timing. Cancer J. 28(3): 208-223.
