Expert Q&A: Hormone Replacement Therapy for Menopause: Is HRT Helpful or Harmful? by Dr. Alan Lindemann

Hormonal shifts during menopause can cause a number of uncomfortable, frustrating and even painful physical and emotional symptoms. Hormone replacement therapy (HRT) provides relief, but many women are hesitant to try it.

When women approach menopause and begin to experience changes in their bodies, their next thought is often how hormone replacement therapy might help. Here are some common questions about hormone replacement therapy.

Q. "What happens during menopause?" 

• Estrogen diminishes. A woman’s ovaries begin to lose their ability to make the estrogen hormone. In time estrogen levels fall to almost nothing.

• Androgens increase. Androgens (a type of hormone) rise during menopause. They are made in the middle of the ovary. The ovary continues to produce androgens after the ovary stops producing estradiol, which is produced in the outer layer of the ovary. Because the estrogen-producing part of the ovary fails to provide enough estradiol, follicle-stimulating hormone (FSH) increases. With menopause, the only part of the ovary which responds to the FSH is the interior, which makes androgens.

• Menopausal symptoms set in. Lack of estradiol cause the hot flashes, night sweats, irritability and vaginal dryness. Androgens cause facial hair, acne and weight gain.

Q. "What does hormone replacement therapy do?"

• Eases the Symptoms of Menopause: Prescription products can ease symptoms such as hot flashes and vaginal dryness.

• The Risks: Though hormone replacement therapy has been shown to be a seemingly simple solution to menopausal symptoms, there are serious risks to taking some of these medications. Those who are treated with the artificial form of these hormones have been shown to be at greater risk for heart attacks, blood clots, strokes and breast cancer. The highly regarded Women’s Health Initiative study of postmenopausal women did not look at estradiol replacement. However, of the three groups in the study, the group that received natural progesterone generated the best results.

Q. "Is there a way to safely take hormone replacement therapy?"

• Opt for natural hormones. Taking a single hormone, estradiol, rather than a combination of synthetic hormones (Premarin and Provera) seems to have some positive effects. If a woman does choose hormone replacement therapy, she should be sure she is taking estradiol or natural progesterone (both natural hormones), or both. In my opinion, hormone replacement is beneficial as long as the hormones are natural, not synthetic.

• Start right away. Women who decide to engage in hormone replacement therapy should start it immediately after menopause. A Danish study showed that when people waited for five years after menopause before beginning hormone replacement therapy, there were no benefits.

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