Should You Consider Hormone Replacement Therapy (HRT) in Menopause?

Changes Brought About by Menopause

With age, a woman’s ovaries begin to lose their ability to make estrogen in the outside layer of the ovary (cortex). As menopause progresses, the estrogen made in a women’s cortex begins to gradually decrease until the estrogen produced falls to almost nothing.

Frigga, a Mare Used to Produce Premarin

During menopause, the hypothalamus senses the drop in estradiol and begins to increase follicle stimulating hormone (FSH) to try to replace what the ovary cortex is no longer producing, but since the ovary cortex can no longer produce estrogen, the estrogen levels fall and androgens, hormones produced in the central part of the ovaries, increase. The increase in androgens from the central part of the ovaries leads to the growth of hair on the faces of post-menopausal women.

The Women’s Health Initiative (WHI) Study

No discussion of hormone replacement therapy (HRT) in menopause can overlook the often-mentioned study of the National Heart, Lung, and Blood Institute called the Women’s Health Initiative (WHI). Up to this time, the early ’90s, there had been few studies of why women seemed to develop as much risk of heart attack as men once they reached menopause. The WHI study was designed to see if replacing the hormones women stopped producing as they moved into menopause would prevent some of the heart disease and bone loss which seemed to occur with menopause. The original study subjects were divided into three groups:

1   premarin only,
2   premarin and provera, and
3   premarin and natural progesterone.

Premarin is manufactured from the urine of pregnant mares. This has always been an issue with those concerned about the humane treatment of animals. Gentle Giants Horse Rescue has a good article on what it takes to produce and collect the urine from pregnant mares for the production of Premarin. One of Gentle Giant’s rescues, Frigga, was chained in a barn with a urine collection bag tied to her leg for many years.

Risks in HRT Therapy

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 WHI study did not look at replacement of estrogen with estradiol. However, the group that received natural progesterone (Group 3) generated the best results of the three groups.

By 2005, it had become apparent that the combined hormone replacements used in the study actually increased risks for breast cancer and heart disease. The study was then discontinued.

Subsequent studies have found taking a single hormone rather than a combination of hormones seems to provide some protection. If a woman decides to go on hormone replacement therapy, it should be started immediately after menopause. A Danish study shows that waiting five years after menopause to begin hormone replacement therapy shows no benefit to hormone replacement. It should also be noted that this Danish study used estradiol rather than a form of estrogen produced from pregnant horse urine.

Is there a way to safely take HRT?

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, and treatment to reduce menopausal symptoms begins with the onset of menopause or shortly thereafter.

 

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Dr. Alan Lindemann

Obstetrician-Gynecologist (OB/GYN)​

He is an obstetrician and maternal mortality expert with 4 decades of medical practice beginning in Minnesota and presently in North Dakota. He has delivered around 6,000 babies with zero maternal deaths.