“Hormone therapy causes breast cancer”… “Bioidentical hormones are safer than synthetic hormones”… “Hormone therapy is dangerous and should be avoided”!
Have you ever encountered these phrases – from social media, friends, or family? If so, you aren’t alone: menopause hormone therapy has had a tumultuous history, namely since the publication of a landmark Women’s Health Initiative research study published in 2002. The findings from this research study, while insightful, were largely misrepresented by the media at the time. Additionally, many aspects of the research study were flawed. Since the publication of this research study, misinformation surrounding the use of menopause hormone therapy has prevailed and has recently become more widespread as menopause becomes part of public conversation.
Hormone therapy remains the gold standard for the treatment of bothersome hot flashes, vulvar, vaginal, and urinary tract symptoms experienced during menopause, and for protection against bone loss and fractures.
20+ years later, we now know the true risks of hormone therapy are far more nuanced than originally reported in 2002. Additional follow-up data from the Women’s Health Initiative research study, with the addition of new studies, have provided us with additional insight and clarification on the appropriate use of hormone therapy for the treatment of menopause symptoms.
At HerMD, we’ve heard your most pressing questions about the use of hormone therapy. We understand you may have questions about whether you may be a candidate to receive hormone therapy and concerns about the risks associated with its use. As we believe education is the cornerstone of change at HerMD™, we’ve compiled a list of your most frequently asked questions about hormone therapy, along with evidence-based answers, to equip you with factual information needed for you to make the most informed decisions about your menopause care.
At HerMD™, evidence-based clinical guidelines and up-to-date research are the foundation upon which we practice. Our team of expert HerMD™ clinicians will leverage these principles to help you understand the anticipated benefits and risks of treatment with hormone therapy, unique to you.
Our approach to treatment with hormone therapy is not “one-size-fits-all”, and we at HerMD™ will utilize this framework to ensure your clinical outcomes are maximized and any potential risks are minimized.
Hormone Therapy FAQs
Is hormone therapy safe?
For the appropriate candidate*, hormone therapy is a safe and effective choice for the treatment of hot flashes and night sweats (also referred to as vasomotor symptoms), genitourinary syndrome of menopause (symptoms that affect the vulva, vagina, and urinary tract during perimenopause & menopause), primary ovarian insufficiency (a condition that occurs when the ovaries lose function before the age of 40), and for protection against bone loss and fractures.
Largely, the safety of hormone therapy was called into question in 2002 when media headlines touted the suspected dangers of hormone therapy use: 41% increase in strokes, 26% increase in breast cancer, 29% increase in heart attack, and a more than double risk of blood clots. Women went off hormone therapy in droves overnight. The utilization of hormone therapy prescriptions in postmenopausal women went from 112 million prescriptions in 2001 to 32 million prescriptions in 2008, a 70% decrease in usage.
The truth? We now know that the study had many flaws (far too many to debunk here), originally reported results were misrepresented, and we have since obtained much more research and data which has provided us with insight into the true benefits and risks associated with hormone therapy.
Who is the “appropriate candidate” for receiving treatment with hormone therapy?
For the appropriate candidate, the benefits of taking hormone therapy should outweigh the risks. To determine the appropriate candidate for treatment with hormone therapy, a HerMD™, healthcare clinician will conduct a thorough review of your personal and family health history, the severity of symptoms you are experiencing, calculate your specific risk for developing certain medical conditions, prior use of hormone therapy, and desire to start treatment with hormone therapy. This approach ensures your clinical outcomes are maximized and any potential risks are minimized. Hormone therapy is not a “one-size-fits-all” approach, and we at HerMD™, utilize this framework in our approach to treatment offerings.
You should know that based on recent clinical guidelines issued by The Menopause Society, when hormone therapy is initiated in individuals younger than 60 years of age or within 10 years of menopause onset, the benefits should typically outweigh the risks. You are not automatically precluded from receiving treatment with hormone therapy if you do not meet these criteria, however, your clinician will determine if you are an appropriate candidate to receive treatment, and conduct a detailed discussion with you about the benefits and risks of treatment unique to you.
What are the risks?
The risks of taking hormone therapy differ for each individual, depending on type, dose, duration of use, route of administration, and timing of initiation. Generally, hormone therapy is associated with an increased risk of blood clots, stroke, and certain cancers, although when hormone therapy is initiated in individuals younger than 60 years of age or within 10 years of menopause onset, the benefits of taking hormone therapy, such as alleviating menopause symptoms and bone protection, will typically outweigh these risks. It is also worth mentioning here that hormone therapy may increase an individual’s risk of breast cancer, although the risk is low.
Ultimately, the “best” hormone therapy treatment is one that is targeted to an individual, maximizing therapeutic benefits and minimizing associated risks. Your HerMD™ healthcare clinician will partner with you on your menopause journey and help you understand the anticipated benefits and risks of treatment so that you can make a choice on which kind of hormone therapy is right for you.
Are ‘bioidentical’ hormones safer and more effective than ‘synthetic’ hormones?
Let’s address this question by first defining the difference between ‘bioidentical’ and ‘synthetic’ hormones. By definition, the term ‘bioidentical’ means having the same molecular structure as a substance produced in the body. ‘Synthetic’ hormones have a different molecular structure than the hormones produced by the body, although they may be similar. Both bioidentical and synthetic hormones are produced in a laboratory.
Bioidentical hormones are often discussed in the setting of compounded hormones, which are custom-made hormone therapy treatments prepared by a designated compounding pharmacy. In public discourse, there is messaging that implies bioidentical hormones are safer and more effective than FDA-approved hormone therapy treatments, however, there is little to no evidence to support this claim. Did you know that the FDA has approved certain types of bioidentical hormones? FDA-approved treatments are regulated for dose, safety, and adverse events, whereas compounded medications are not as closely monitored or regulated.
If I start on hormone therapy, how will I be monitored?
If you’ve made the decision to move forward with hormone therapy after a discussion with your HerMD™ clinician, part of this discussion would have included targeted goals for your treatment. It has been well-established that the goal of treatment with hormone therapy is to manage, and ultimately, improve, any menopause symptoms you may be experiencing.
We will monitor your response to treatment based on the extent to which your menopause symptoms improve after starting hormone therapy, as well as any potential side effects you may experience. At HerMD™, we believe your healthcare is personal, and we partner with you to ensure you receive the best health outcomes. In the setting of administration of hormone therapy, we will see you, in person or virtually, at certain intervals to evaluate certain components of your health. We may use labs to provide insight into important clinical information, one of the many facets of evaluation to manage your delicate interplay of multiple menopause symptoms.
Are most other women who are in menopause taking hormone therapy?
You may hear many personal accounts from women who have decided to start treatment with hormone therapy to address their bothersome menopause symptoms.
However, based on recent research reported by The Menopause Society, hormone therapy usage rates are at an all-time low: <4% of women aged 50 to 59 took hormone therapy to alleviate their menopause symptoms in 2023. This low usage rate may reflect women’ s continued skepticism surrounding the safety of hormone therapy, further highlighting the need for additional education and transparency regarding the true benefits and risks of hormone therapy.
Sources
The Menopause Society Statement on Misinformation Surrounding Hormone Therapy. The Menopause Society. Accessed November 12, 2024. https://menopause.org/wp-content/uploads/2024/09/TMS-statement-on-HT-Misinformation.pdf
Writing Group for the Women’s Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women’s Health Initiative Randomized Controlled Trial. JAMA. 2002;288(3):321–333. doi:10.1001/jama.288.3.321
Stagnitti M, Lefkowitz D. STATISTICAL BRIEF #347: Trends in Hormone Replacement Therapy Drugs Utilization and Expenditures for Adult Women in the U.S. Civilian Noninstitutionalized Population, 2001-2008. Agency for Healthcare Research and Quality. November 2011. Accessed November 12, 2024. https://www.meps.ahrq.gov/data_files/publications/st347/stat347.shtml
“The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028
Menopause Topics: Hormone Therapy. The Menopause Society. Accessed November 12, 2024. https://menopause.org/patient-education/menopause-topics/hormone-therapy
Bioidentical, Compounded Hormones Commonly Used by Perimenopausal Women, But No Consistency. MGH Center for Women’s Mental Health. July 29, 2019. Accessed November 12, 2024. https://womensmentalhealth.org/posts/bioidentical-hormones-in-perimenopause/
The medical content in this article has been reviewed for accuracy by Karla Loken, DO, OBGYN, FACOOG