Hormone replacement therapy

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The decline in hormones that begins during perimenopause is primarily responsible for the changes in a woman's body during this phase and, in some women, causes symptoms of varying severity.

Given this scenario, it's natural to think:

"If I replace these hormones, will the symptoms go away?"

Probably yes. But choosing a treatment like this involves significant health risks that should be considered together with a healthcare professional.

In the early 1960s, hormone replacement therapy became very popular among women in perimenopause and post-menopause, reaching its peak usage around the 1990s, then dropping dramatically after 2002, when a Women's Health Initiative study had to be halted due to increased breast cancer risk.

Since then, there has been much controversy regarding the use of this type of therapy, until in 2009, after a detailed literature review, the Endocrine Society Scientific Statements evaluated the risks vs. benefits and determined that hormone replacement can indeed be beneficial, as long as two criteria are met:

1. Is the woman under 60 years old?
2. Did the woman go through menopause less than 10 years ago?

If the answer is yes to both questions, hormone replacement therapy can be safely considered, as long as the woman and her healthcare provider are in agreement.

Otherwise, the risks may outweigh the benefits of therapy and other options should be considered.

But what exactly are these risks and benefits?

The risks include:

Increased risk for certain types of cancer

A 2020 study demonstrated that the use of therapy was associated with a higher risk of breast cancer, both in combined therapies and estrogen-only therapies.

In 2016, it was observed that this type of therapy is also related to an increased chance of a woman developing endometrial cancer.

Lastly, regarding ovarian cancer, there is still significant debate: on one hand, some studies show an increased risk while other experts suggest that this risk does not increase with combined therapies.

Increased risk for blood clots and stroke

Studies have shown that hormone replacement therapy (mainly in pill or patch form) can increase the risk of blood clot formation and stroke, and that this risk increases with the duration of treatment.

Given this scenario, specialists in the field recommend the lowest dose of hormone replacement for the shortest time possible and never in women over 60 years old.

Increased risk for gallbladder disease

One of the adverse effects of estrogen replacement is increased cholesterol concentration in the gallbladder and, consequently, there is an increased likelihood of gallstones, being more common in women on hormone therapy for more than 5 years.

What about the benefits?

We have those too!

• Reduction of main symptoms

Studies have shown improvement and reduced frequency of hot flashes and night sweats in women who used low doses of estrogen.

Low-dose estrogen has also proven effective in reducing genital tract symptoms such as vaginal dryness and pain during sex, as well as acting on urinary tract symptoms such as overactive bladder, for example.

Decreased risk for osteoporosis

Hormone replacement, alone or in combination, has strong scientific evidence for preventing bone density loss and reducing fractures, being the first-line treatment for postmenopausal women at high risk of fracture, as long as they are under 60 years old.

Protection against cardiovascular disease

Studies confirm the benefit of this type of therapy, when done early, for a woman's vascular system and heart. For this, the doctor usually orders some tests to check the woman's heart health. These tests should be repeated annually while treatment is ongoing.

Prevention of Alzheimer's disease and Parkinson's disease

According to a study conducted in 2020, estrogen-only hormone therapy may have a protective effect against some neurological conditions, being more favorable for reducing the risk of Alzheimer's and Parkinson's disease.

"So, is hormone replacement right for me?"

The best person to answer this question is yourself, after talking with a healthcare professional you trust, analyzing all the risks involved, and having already tried all available alternatives for symptom reduction. You can opt for hormone replacement if you understand that the benefits outweigh the risks in your case.

Therapy can be done through pills, transdermal patches, injections, topical creams, and vaginal rings. This choice should also be made in agreement with your doctor.