Pros and Cons of HRT

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How to Make a Sound Decision as You Enter Menopause

When it was first introduced, hormone replacement therapy (HRT) seemed almost too good to be true: a little pill could squash your symptoms and lower your risk for major diseases that target postmenopausal women. However, studies, advancements in research, and long-term evidence has built up over the last two decades to complicate the case for hormone replacement — and many women are left wondering what to think about it.

You may have heard peers and doctors take staunch stances on the matter, but the question to replace your falling estrogen and progesterone levels is an individual one. There are important personal factors to consider when you make your decision, including age, symptoms and health history.

It can be challenging to comb through all the facts and arguments on hormone therapy, but the more you know about your own position, the better situated you’ll be to make the right decision. Here are some of the pros and cons of HRT, and a few other points to help you on your way.

Benefits to Consider

While HRT cannot take care of all your menopause symptoms, or the postmenopausal health risks that arise, experts have confirmed that beginning hormone therapy shortly after you’ve entered menopause can help in two important aspects:

Fewer Symptoms

Over 70 percent of women experience menopause discomforts like hot flashes, sleep problems and mood changes at some point; an unlucky 20 percent will have severe symptoms that greatly interfere with their daily life. Obviously, any remedy that promises to reduce those pesky menopausal problems is worth considering.

HRT is widely considered one of the best treatments for some of the most common menopausal symptoms: hot flashes, night sweats, vaginal dryness, sleep problems and mood changes. This is the case for both perimenopausal women and postmenopausal women.

Better Bone Health

Your risk for osteoporosis begins to climb as soon as your estrogen levels begin to permanently drop, and that is cause for concern. Luckily, HRT is incredibly effective when it comes to stopping bone loss.

It’s true that there are other medications that help ward off osteoporosis, but they can bring more side effects than HRT for many women. If your doctor has determined that you’re at a heightened risk for bone problems as you transition into menopause, it may be time to consider HRT.

Why HRT May Not be the Right Choice

Since its inception in the 1970s, right up until the beginning of the 21st century, HRT was a clear choice for menopausal women. It promised to eradicate many uncomfortable symptoms and set the stage for a long and healthy post-menopausal life.

That changed in the summer of 2002, when a massive and revolutionary study out of the Women’s Health Initiative uncovered some startling realities.

The study followed postmenopausal women on two drugs (Premarin and Prempro) to see how well the medications could prevent heart disease. Unfortunately, they found that the very opposite appeared to be true: heart disease risk actually went up, along with some other potentially life-threatening diseases.

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Blood Clots — and Their Dangerous Consequences

The ground-breaking 2002 study revealed that women on HRT were actually at an increased risk for blood clots and coronary artery disease — a finding that contradicted the previous line of thinking. Since so many women began HRT precisely to protect against the rising risk of heart disease after menopause, these findings could not be ignored.

Not surprisingly, a higher risk of blood clots is tied to a higher risk of stroke (a blockage in your brain) and pulmonary embolism (a blockage in your lung), and that has scared many women away from the therapy. Deep vein thrombosis in the legs is another clot-related problem to consider with HRT.

However, there’s no consensus on just how much your stroke risk increases; some experts insist that a lot has to do with the form of HRT you take, and when you begin to take it.

Higher Risk of Certain Cancers

The research from 2002 also indicated a higher risk of breast cancer among women who were on HRT. And for those taking estrogen-progestin hormone therapy, studies show that breast cancer will spread to the lymph nodes much more quickly than in women who are not on combined HRT. Estrogen-only hormone therapy doesn’t seem to increase breast cancer risk, but it’s typically only given to women who have had a hysterectomy.

A recent article in medical journal The Lancet showed 50 studies tying HRT to a higher risk of ovarian cancer, which has alarmed many women, given the grim outlook and high fatality rates of the disease. However, genetic makeup also plays a big role in ovarian cancer risk, especially regarding certain gene mutations.

In the end, women who start the therapy later seem to be at the biggest risk for various complications and serious diseases. In addition to age, you should consider:

  • BMI. HRT may not be suited to women who are very overweight
  • Smoking history. Smokers are at an increased risk for side effects, especially in relation to blood pressure and blood clot risk.
  • Blood pressure. High blood pressure can climb even higher on HRT.
  • How long you’ve been menopausal. When started soon after menopause begins, the risks appear to be much lower — in fact, a 2006 study found that your risk of heart disease could indeed go down by up to 30 percent.

Up until age 60, the benefits of HRT often outweigh the risks, but only you and your doctor can determine if HRT is the best course of action for you. If you’re not comfortable with taking the commonly prescribe hormone therapy, there may be a middle ground to balance risk and reward.

The Alternatives to Conventional HRT

If you decide that HRT isn’t for you, don’t despair — there are other options. Some women find that plant-derived estrogen (from soy or other substances) improves their symptoms and helps ease the transition, and these may carry fewer risks than HRT.

In other cases, it makes sense to treat your individual symptoms directly: countering vaginal dryness with lubricant, mood swings and sleep problems with antidepressants, and herbal tea to relax and emotionally regroup.

No matter what course of action you take, you should make exercise a part of your regular routine. Not only will it reduce stress and improve your sleep, it can help keep your bones strong and dense. In the end, a healthy lifestyle will always put you one step ahead.

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