Women in their 40s and 50s are seeking care to address the daily symptoms associated with perimenopause and menopause. They also want the best preventive and protective care to ensure a vibrant and long health span. Hormone Replacement Therapy (HRT) can address daily menopausal symptoms and interrupt the disease process that begins as hormone levels decline. In other words, HRT can help you feel better, function better, and live disease-free for longer.
Understanding Hormonal Changes and Their Impact
During perimenopause and menopause, all women experience a dramatic shift in hormone levels. For many women, this change leads to a measurable decrease in wellbeing. Estrogen, androgens, and progesterone play significant roles in women’s health, offering protection against everything from stress and poor glucose metabolism to cardiovascular disease and bone loss.
Symptoms and Long-term Effects of Menopause
Some of the ways menopause reduces wellbeing are more overt and immediate, such as hot flashes, night sweats, hair loss, and joint pain. Sleep disruption is very common, and with it come complaints of brain fog and often increased feelings of anxiety and depression. As the body attempts to compensate for lost hormones, women experience mood swings, unwanted hair growth, decreased libido, and painful sex. Body composition changes, favoring the accumulation of visceral fat and a frustrating loss of muscle mass are some examples. Many women find great difficulty in losing unwanted weight and watch blood pressure readings and cholesterol levels creep up. The lack of estrogen over time is thought to contribute to the gradual development of cardiovascular disease, cognition problems, diabetes, and osteoporosis.
The Current State of Treatment
Unfortunately, of the women who report these concerns and ask for support from their providers, only 10 percent are offered any kind of therapy. Of those who are offered therapy, most will be given an antianxiety medication and/or a statin. While these can be effective therapies, in our opinion, they are not sufficient to treat the global needs of a woman during the menopausal years. While not every woman can, should, or will want to use HRT, we strongly believe that every woman deserves the chance to have a conversation about it and to explore the ways it can help her thrive now, and 30 plus years from now.
A Historical Perspective: The Women’s Health Initiative
This wasn’t always the case. There was a time that 40% of menopausal women were using HRT to improve their wellbeing. Enthusiasm for this kind of treatment declined in 2002, largely due to misinformation about a once-promising study known as The Women’s Health Initiative (WHI).
In the 1990s, the WHI embarked on a very large randomized controlled study of menopausal health. The study hoped to answer whether estrogen and progesterone replacement would indeed provide heart-disease protective effects to post-menopausal women, as some smaller studies had suggested.
The study was showing promise; however, in 2002 a news conference meant to update the public on the study led to misconceptions and a quick pivot away from using and prescribing HRT. Of the 3 groups studied, the group that was given combined hormone replacement therapy (HRT) of estrogen plus progestin was associated with an increased risk of breast cancer. Specifically, a 24% relative increase in the risk of breast cancer for women using this combined HRT compared to those who did not use it.
In absolute terms, this translated to an increase from about 4 cases per 1,000 women per year in the placebo group, to about 5 cases per 1,000 women per year in the combined HRT group. This means that for every 1,000 women taking the combined HRT, there was one additional case of breast cancer per year compared to women not taking this form of HRT. This is a much smaller increase than the relative risk suggests.
More Flaws in the WHI Study
Age of Participants: The WHI study included women whose average age was 63, meaning they had already been in menopause for several years. This is significant because starting HRT years after menopause may not provide the same benefits as starting it closer to the onset of menopause.
Exclusion of Symptomatic Women: The study excluded women experiencing hot flashes, which are a common symptom of menopause. This exclusion meant that the study results were less applicable to women who might seek HRT for symptomatic relief, and less applicable to women who are in perimenopause and early menopause stages.
Type and Dose of Hormones: The hormones used in the WHI study were not bioidentical and were given in doses that are not typically used in modern HRT practices. The study used conjugated equine estrogens and medroxyprogesterone acetate, which differ from the bioidentical hormones that many practitioners now prefer.
Misinterpretation of Cardiovascular Risk: The WHI study found a slightly increased risk of stroke in the estrogen-only group. However, subsequent analysis has shown that starting HRT closer to the onset of menopause can have cardiovascular benefits, reducing the risk of heart disease by as much as 50% when started between ages 50-59. Estrogen is best at preventing heart disease.
Positive Findings Overlooked: The study also found some positive effects, such as a lower incidence of colon cancer and improved bone density, which were often overlooked in the sensationalized reporting.
Correcting Misconceptions and Moving Forward
By highlighting these flaws, we aim to provide a more accurate understanding of the WHI study and its implications for HRT. This information can help women make more informed decisions about their health and treatment options. Rather than this information scaring women away from a possible treatment, we hope that it opens up an intelligent conversation about the unique risks and benefits for each woman who considers HRT.
The misinterpretation and sensationalized reporting of the WHI study results led to widespread fear and a dramatic decrease in HRT prescriptions. However, further analysis and subsequent studies have clarified that HRT can be safe and beneficial for many women, especially when started at the appropriate time and with the right formulations.
Benefits of Hormone Replacement Therapy
If you start Hormone Therapy between the ages of 50-59, you have a significantly decreased risk of heart disease. Estrogen is best at prevention rather than cure, and its benefits are more pronounced when HRT is started close to the onset of menopause. Generally, estrogen is neuroprotective, and long-term use has been associated with better brain health.
Hormone Replacement Therapy is one treatment that is helping many women feel great and improve their biometric measures of health. HRT can quell those hot flashes, boost your metabolism, and soothe moods. A low dose of HRT can be highly effective at erasing the mysterious anxiety and depression that seem to arrive out of nowhere. Studies indicate that HRT also offers protective effects to prevent or reduce the likelihood of osteoporosis, diabetes, heart disease, and more. This is often a time of life when women are turning more of their attention back on themselves after intensive tending to the needs of family. Perimenopause and menopause is an excellent time to put your health first and hormone therapy is one effective option.
Why Med Matrix?
At Med Matrix, you can learn about your hormone levels and how they are affecting your wellbeing. Even the slightest imbalance can cause fatigue, reduced sex drive, difficulty losing weight, and more. Med Matrix can help you reclaim your natural balance and start feeling like you again.
Hormone Replacement Therapy (HRT) is one of many options available to support healthy aging at Med Matrix. With our focus on whole-person health and individual testing, IFM providers are uniquely poised to match women with the best options in HRT. We work to match your individual needs and coordinate the best timing, dose, and method of delivery for you.
Steps to Get Started
Initial Consultation: Meet with our patient coordinator for a 20-minute meeting to discuss your concerns and goals.
Hormone Testing: Comprehensive testing to understand your hormone levels.
Personalized Plan: Our providers will create a tailored plan for HRT based on your unique needs and health history.
Follow-Up: Regular follow-up meetings to adjust therapy and ensure optimal outcomes.
Benefits of HRT
- Reduced Hot Flashes
- Reduced Risk of Heart Disease
- Improved Focus & Energy
- Improved Cholesterol Levels
- Reduced Weight Gain, Particularly in the Midsection
- Better Sleep
- Improved Libido
- Reduced Risk of Osteoporosis
