Lately, the world of hormone replacement therapy (HRT) has become a trending topic in the health and wellness space. When it comes to this topic, it can be hard to know what’s true and what’s just opinion, so we asked Hillary Neighbors, MSN, NP-C who works within the OB-GYN Specialty at CMG Women’s Center, to answer some frequently asked questions about HRT which is also known as menopause hormone therapy (MHT).
What is MHT, and who is it typically recommended for?
Menopause hormone therapy is estrogen, progesterone or a combination of both taken to replace the estrogen the body stops making after menopause. This course of therapy is intended for those who are within 10 years of menopause onset, usually ages 50-60. Menopause is defined as one full year without a menstrual cycle.
What symptoms or conditions can MHT help alleviate?
Hot flashes and vaginal discomfort are common indicators of low estrogen that may be resolved through MHT. Insomnia, irritability, night sweats, urinary leakage and abdominal weight gain are also reported symptoms that can be treated.
What are the potential risks and side effects of MHT?
If you still have a uterus (have not had a hysterectomy), your provider will prescribe progesterone along with estrogen to prevent excessive build-up of the uterine lining which can increase risk of endometrial cancer. For some, MHT may increase risk of heart disease, stroke, blood clots, breast cancer, gallbladder disease and endometrial cancer, so we discuss this prior to beginning.
How long do most patients stay on MHT, and how is treatment monitored over time?
Treatment with MHT is based on symptom control. Usually, the goal is to use the least amount of hormone dosage that is effective for the shortest duration of time. That can vary depending on patient symptoms, age of menopause onset and underlying health problems.
While there is not an exact time limit, after the age of 60, risks can increase. As time goes on, we may attempt to wean the patient and discontinue usage based on discussion of symptoms, risks, benefits and other risk factors which are individual to them.
What are some misconceptions about MHT that you’d like to address?
The Women’s Health Initiative (WHI) study done in 2002 caused a lot of concern amongst prescribers and patients given findings of increased breast cancer and stroke risk associated with a combination hormone replacement known as ‘Prempro’. This type of MHT is a combination of conjugated (equine) estrogen and a type of progestin called medroxyprogesterone. Risks with this combination were still low, but statistically relevant. For years following, many doctors were hesitant to prescribe MHT, leaving women without adequate symptom relief.
Now, we are learning that it can be beneficial for those without contraindications to receive estrogen replacement in the early post-menopausal period (first 10 years), and benefits generally outweigh risks in this period. The estrogen we prescribe is typically bioidentical-ethynyl estradiol, not conjugated estrogen. Micronized progesterone is also bioidentical.
Is there anything else you would like to share?
Bioidentical hormone clinics are becoming more popular. These clinics offer testing and hormonal treatment with compounded medications such as creams, injections and pellets, but usually this is not covered by insurance. The American College of Obstetrics and Gynecology (ACOG) recommends Food & Drug Administration (FDA) approved menopausal hormone therapies as opposed to compounded bioidentical hormones as these lack FDA approval which raises concerns about quality, purity and potency. There is currently no scientific evidence to support better safety using compounded bioidentical hormone therapies over FDA-approved MHT.
