We asked our friend Ob/Gyn Dr. Sherry Ross why it’s so darn hard to get a straight answer on the subject of HRT. “Here’s the problem,” says Dr. Sherry, “ women and even some doctors are still completely confused about the safety of taking hormone replacement therapy. Myths, medical misinformation, and your BFF are all to blame for the lack of clarity about who should start HRT and when. So even if you feel as though you are going completely insane when each new hormonal cycle begins, you aren’t quite sure about the risk and the reward of taking natural or synthetic hormones. Menopause is the beginning of your new “normal” so perhaps it is time to pick and stick .”
For years, HRT has been taking a rap that it puts women at an increased risk for heart attack and does more harm than good. But when you look at the latest evidence, “That’s just not true,” says Holly L. Thacker, M.D., a menopause specialist at the Cleveland Clinic. “Short-term use of HRT, up to a few years, is safe for most women who are in their 40s and 50s,” she says. “Most women overestimate the risk of hormone therapy and underestimate the risk of not treating their hormone deficiency.” The North American Menopause Society (NAMS,) which is the medical organization making the HRT rules, supports the benefits of HRT for hot flashes, insomnia, night sweats and confirms that hormone usage outweighs the risks for women under 60, within a decade of the onset of menopause without other contraindications.
Now if you ask ten of your girlfriends of a certain age how menopause is affecting them, you’ll get at least ten different answers. Everyone has a different story to tell, and certainly, everyone has their own take on the merits and demerits of HRT. The good news is for women who are suffering from debilitating symptoms of menopause, help is available in the form of hormones. HRT is not a one size fits all prescription. Low-risk peri-menopausal women under 60years or within 10 years of being diagnosed can safely take HRT without fear of an increased risk of breast cancer, heart disease, dementia, and Alzheimer’s. First line options include estrogen in the form of a patch or cream and if you have a uterus; progesterone.
“Medically speaking, ” says Dr. Sherry, “menopause is a natural condition where your ovaries stop producing the estrogen that your body and vagina have, up until then, relied on. When estrogen production fully stops, so does your menstruation. Since the main function of estrogen is to support the development of the female body and the female secondary sexual characteristics, it only makes sense that when estrogen is gone, every part of our body that makes us female is affected, some worse than others.”
For some women, menopause is a hormone deficiency state that needs to be treated—much like you’d need to treat low thyroid with hormone therapy in order to get it back into the right range. “Yes, there are other treatments for your symptoms, but most are no better than a placebo,” she says. “Eating right and exercising are good, and cognitive behavior therapy can be helpful, but you’re not going to exercise your way out of a hormone deficiency,” says Dr.Thacker.
Dr. Ross adds, “Behavioral and lifestyle changes have been known to go a long way in controlling the mild symptoms associated with menopause but all symptoms are not equal and even less so with how they affect your quality of life. Some easy fixes such as: dressing in layers and even carrying a portable fan in your bag can be a simple strategy in combating hot flashes. Eating a healthy colorful diet full of fruits, vegetables, whole grains, and low-fat protein and controlling your BMI is not only helpful for menopausal symptoms but also for healthy aging. Yoga, meditation, mindfulness, acupuncture, and herbal remedies such as passion flower extract, black cohosh, soy and red clover are all healthy alternative for mild symptoms. “
Dr. Thacker notes that most women who go on HRT within 10 years of menopause will have a better quality of life and gain protection from heart disease, diabetes, and breast cancer. Dr. Ross is reluctant to confirm the protection from heart disease and cancer, but she is certain that it will improve your quality of life. HRT can also help with the changes happening to your bones, your sleep, your skin and hair, even your vagina!
“Hormones are potent and whatever you use has to be the right dose, for the right reason, and for the right woman, but there are a lot of different options that can be individualized,” she says. “If you were ever on the Pill, don’t fear HRT. Just look at the facts.”
Dr. Sherry recalls; “As a teenager, I loved the TV series, :”Three’s Company” as much as the next person, but Suzanne Somers would not be my go-to gal on the merits of bioidentical hormones. Compounded bioidenticals have not been tested in clinical trials and are not FDA-approved in the same way as hormone replacement therapy. Many women believe compounded bioidentical hormones are more “natural…and so must be safer, right?” It’s true compounded bioidenticals are made from plant products such as soy and yams, but they still need chemical processing to become active in the body. In truth, many estrogen pills, patches, gels, creams, and sprays are also bioidentical, so just because hormones are termed “bioidentical,” it doesn’t mean that they are more natural. My point is that if you choose to use bioidentical hormones, it’s important to understand that they are not proven to be any safer than conventional HRT. And since we are discussing compounded hormones, don’t bother saliva testing to monitor estrogen levels since the test is well known to be unreliable and emphatically, not recommended, by the American College of Obstetrics and Gynecology.
Most importantly, you must know that you are not going crazy when you enter this life-changing hormonal cycle called menopause. You must have a heart to heart and honest conversation with your doctor to understand that what you are experiencing is entirely normal. Listen to what your body is saying. In order for you to be the best version of yourself, deal confidently with this next life chapter and find safe and trusted solutions that work best for you. Just say no to the menopausal battle cries and if your doctor suggests that hormonal therapy is right for you—believe her!