Living Longer Better with Menopausal Hormonal Therapy

Written By Brittany Busse

Menopause is a natural phase in a woman’s life, marking the end of her reproductive years. But while this process is natural, many women are forced to suffer in silence while healthcare professionals debate the pros and cons of administering therapy due to widespread misinformation about the risks of treatment.

While the timing and experience of menopause vary widely, many women encounter challenging symptoms such as hot flashes, night sweats, mood swings, and vaginal dryness. For some, menopausal hormone therapy (MHT) — previously known as hormone replacement therapy (HRT) — offers relief. However, this treatment comes with benefits and risks that require careful consideration.

In this blog, we will explore the pros and cons of MHT to help women make informed decisions in consultation with their healthcare providers.

What Is Menopausal Hormone Therapy?

MHT involves the use of hormones, typically estrogen and sometimes progesterone and testosterone, to alleviate menopausal symptoms. The therapy is ideally tailored to the individual’s symptoms, genetics, history (especially surgical history), cancer risk, and expectations.

The Pros of Menopausal Hormone Therapy

1. Effective Symptom Relief

MHT is widely recognized for its effectiveness in treating many of the hallmark symptoms of menopause:

  • Hot Flashes and Night Sweats: Estrogen therapy significantly reduces the frequency and severity of vasomotor symptoms, which are often the most distressing for women.

  • Vaginal Dryness and Discomfort: MHT can improve vaginal atrophy and dryness, enhancing sexual comfort and reducing the risk of urinary tract infections.

  • Sleep Improvement: By addressing night sweats, MHT can lead to better sleep quality. Progesterone administration also has an independent relationship to improving the quality and quantity of sleep.

2. Bone Health Benefits

Postmenopausal women face an increased risk of osteoporosis due to declining estrogen levels. MHT has been shown to:

  • Reduce Fracture Risk: Hormone therapy helps maintain bone density and decreases the likelihood of fractures in the spine, hips, and other areas.

3. Potential Cardiovascular Benefits

For some women, particularly those who begin MHT near the onset of menopause, there may be a reduced risk of heart disease. However, the benefits depend on the timing of initiation and the individual’s overall health profile. It is important to consider this with your doctor and having necessary cardiac testing like a Coronary Artery Calcium scan prior to initiating therapy, especially if it has been more than 10 years since the date of your menopause.

4. Improved Quality of Life

For women with severe menopausal symptoms, MHT can significantly improve daily life by alleviating discomfort and supporting emotional well-being.

5. Prevention of Certain Chronic Conditions

Estrogen therapy, particularly when started early, may lower the risk of certain conditions such as Type 2 diabetes and colon cancer. However, these benefits are not universal and should be weighed against the risks.

The Cons of Menopausal Hormone Therapy

1. Increased Risk of Certain Cancers

One of the most significant concerns about MHT is its association with cancer. Although the results of the Women’s Health Initiative implicating MHT (HRT) in the development of cancer was grossly overstated, some women will still need to exercise caution, especially if they have a personal or family history of cancer, or if they have other risk factors:

  • Breast Cancer: Combined estrogen-progesterone therapy is associated with a slight increase in breast cancer risk, particularly with prolonged use.

  • Endometrial Cancer: Estrogen-only therapy increases the risk of endometrial cancer in women with an intact uterus, which is why progesterone is often added.

2. Risk of Blood Clots and Stroke

MHT, especially oral formulations, may increase the risk of blood clots (deep vein thrombosis and pulmonary embolism) and stroke. Women with a history of clotting disorders or other risk factors may need to avoid MHT or consider alternative options. It is impotant to review your genetic risk factors for blood clotting in addition to your MTHFR status with your doctor prior to initiating any kind of hormone therapy. Non-oral therapies are better tolerated and safer for those women at risk for blood clots.

3. Heart Disease Risks for Older Women

While early initiation of MHT might protect against heart disease, starting therapy many years after menopause can increase the risk of coronary events. Again, this is why it is important to establish a cardiac health baseline with a doctor familiar with these risks prior to initiating MHT.

4. Side Effects

Some women experience side effects that make MHT less appealing, including:

  • Breast tenderness or swelling

  • Nausea

  • Bloating

  • Mood changes

5. Individual Variability

The risks and benefits of MHT can vary significantly from one woman to another, depending on factors like age, medical history, and how long the therapy is used. This variability makes a personalized approach essential.

Who Should Consider MHT?

MHT is not suitable for everyone. Women who may benefit most include those with:

  • Moderate to severe menopausal symptoms that significantly impact quality of life.

  • Early menopause or premature ovarian insufficiency (before age 40), as these women face greater risks of osteoporosis and heart disease without hormone therapy.

Conversely, women with a history of breast cancer, blood clots, stroke, or certain other medical conditions may be advised against MHT.

Alternatives to MHT

For women who cannot or choose not to use MHT, there are alternative treatments:

  • Non-Hormonal Medications: Certain antidepressants, gabapentin, and clonidine can help with hot flashes.

  • Lifestyle Changes: Regular exercise, a healthy diet, stress reduction techniques, and avoiding triggers like caffeine and alcohol can alleviate symptoms.

  • Natural Remedies: Herbal supplements like black cohosh or soy isoflavones may offer mild relief, though evidence is mixed, and safety should be discussed with a doctor.

Making the Decision

The decision to use MHT is highly personal and should be guided by a thorough discussion with a healthcare provider. Key considerations include:

  • The severity of symptoms

  • Personal and family medical history

  • The woman’s preferences and lifestyle

Conclusion

Menopausal hormone therapy can be life-changing for many women, providing relief from disruptive symptoms and improving overall quality of life. Because MHT can lower heart disease risk, reduce the risk of neurocognitive disease, and reduce your risk of fracture it has been recognized as a longevity enhancing treatment for most women. However, it is not without risks, and the decision to use MHT should be made with careful thought and medical guidance. By weighing the pros and cons, women can navigate menopause with confidence and choose the path that best aligns with their needs and health goals.

Brittany Busse
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