Hormone Replacement Therapy (HRT): The Elephant in the Room

 

Conventional Medical Guidelines:

• American College of Obstetricians and Gynecologists (ACOG)

• Summary of ACOG: Feel that HRT is generally safe if started within the first 10 years of menopause; feels systemic estrogen (with or without progestin) is helpful in relieving vasomotor symptoms of hot flashes and night sweats; also both systemic and topical can help with vaginal dryness.

• ACOG does not recommend HRT with a history of breast or endometrial cancer, stroke, heart attack, Blood clots, liver disease. Recommend as protective for osteoporosis. Mixed reviews for heart disease prevention. Some studies suggest that combined therapy may be helpful if started within 10 years of menopause and for women < 60 yrs old. May be a risk of increased heart attack.

• Do not promote Bioidentical Hormone Replacement (BHRT) as they are concerned about compounding facilities and is not FDA approved. Please see site above for further information.

• NAMS: (National Association of Menopause Society)

 

Highlights From the 2022 Hormone Therapy Position Statement of The North American Menopause Society

• Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture.

• Personalization with shared decision-making remains key, with periodic reevaluation to determine an individual woman’s benefit-risk profile… to manage symptoms and meet treatment goals. The benefits of hormone therapy outweigh the risks for most healthy symptomatic women who are aged younger than 60 years and within 10 years of menopause onset.

• Transdermal routes of administration and lower doses of hormone therapy may decrease risk of venous thromboembolism and stroke.

• Breast cancer risk does not increase appreciably with short-term use of estrogen-progestogen therapy and may be decreased with estrogen alone.

• Have concerns about Compounded bioidentical hormone therapy related to minimal government regulation and monitoring.  Feel risks with overdosing or under dosing, presence of impurities/possible sterility issues, site lack of scientific efficacy.

• However, hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 for persistent vasomotor systems, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.

 

Integrative /Functional Approach - Integrative medicine takes a more nuanced view.

• The functional approach stresses the importance in obtaining a complete medical history and assess the risks and benefits of HRT for each individual woman. 

• Bioidentical Hormone Replacement Therapy (BHRT) is embraced as a safer form of progesterone and estrogen.

• BHRT from a certified compounding safe and can individualize amounts both orally and topically.

• Progesterone (not progestin) can be given alone to help alleviate mood and sleep issues.  Prometrium (Rx natural progesterone), can be prescribed, but is soaked in peanut oil, so cannot use if allergic to peanuts.

• BHRT aims to restore a woman to age-appropriate physiological hormone balance, to help with menopause symptoms, brain protection and cardiovascular system. 

• Currently many research articles now supporting BHRT suggest that BHRT could be initiated earlier, starting in peri-menopause to protect women’s both brain and heart.  

• Overall perspective: Estrogen in and of itself does not cause Breast CA. It is a combo of genetics, individual health history, environmental factors, nutrition, and lifestyle.

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Please see practitioners under Resources that recommend this integrative approach.

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