A new study has determined that, when it comes to treating the symptoms of menopause, the overall benefits of hormone replacement therapy outweigh the risks. However, researchers found that the evidence does not support hormone therapy as an effective preventative measure for cardiovascular disease, dementia, or other chronic diseases.
The study, published in the Journal of the American Medical Association (JAMA), analyzed follow-up data related to the Women’s Health Initiative (WHI) study—the largest study for women’s health in the United States and a nearly two-decade-long undertaking. The researchers determined that hormone therapy is an effective treatment option for postmenopausal women, particularly those in early menopause who are less than 60 years old.
Study Findings Explained
The WHI study was conducted from 1993 through 1998. Participants consisted of 161,808 postmenopausal women within the United States between 50 and 79 years old. Relevant data was collected from the study participants for up to twenty years to determine the efficacy and side effects of hormone replacement therapy during menopause.
After analyzing the WHI’s follow-up data, the JAMA study researchers concluded hormone replacement therapy (HRT) is a safe treatment option for common vasomotor menopause symptoms, such as hot flashes and night sweats. The researchers also found that initiating hormone replacement therapy in early menopause (before age 60) resulted in fewer adverse effects compared to late menopause.
“I’m glad to see the researchers mention the increased risk of side effects from HRT in late menopause. I wish doctors would be more upfront with patients about the downsides of HRT, because the truth is, it doesn’t work well for a lot of women,” Mindy Pelz, a chiropractor and functional health expert, told The Epoch Times in an email.
Researchers also found the evidence did not support routine calcium and Vitamin D supplementation to prevent fractures in postmenopausal women. Nor did it support the use of a low-fat diet as a means to prevent breast or colorectal cancer in postmenopausal women.
“It’s always good to get more clarity on what hormone replacement can and cannot do. For some women, hormone replacement therapy makes a night-and-day difference in menopause symptoms like hot flashes and mood—but it’s helpful to know that HRT won’t protect you from menopause’s impact on heart health, brain aging, and chronic disease risk,” says Ms. Pelz.
Background and Prior Research
Through decades of research, scientists have been able to better understand which hormone treatments are beneficial–and which should be avoided. For example, researchers of the WHI study learned that a certain type of progestin—medroxyprogesterone acetate—was linked to higher rates of breast cancer. On the other hand, micronized progesterone, a type of bioidentical hormone, does not increase the risk of breast cancer.
“Bio-identical hormones are a safer alternative to traditional HRT because they are plant-based transdermal creams that are structurally identical to human hormones; the body recognizes them, binds to them, metabolizes them, excretes them, activating the same functions as before menopause sets in. They are just as powerful to prevent hot flashes, night sweats, weight gain, and sleeping difficulties and do not pose an increased risk for breast cancer, heart disease, blood clots, or strokes,” Dr. Gowri Reddy Rocco told The Epoch Times in an email. Dr. Rocco is a double board-certified physician in family medicine and regenerative, anti-aging, and functional medicine.
The WHI study also found an increased incidence of pulmonary embolism in women taking estrogen orally. Other forms of estrogen, such as patches, creams, or gels, are considered a safer option because they are not metabolized by the liver.
“It is imperative to recognize that the WHI study only studies results of using synthetic, oral estrogens and progestins. It is important to clarify the confusion so women feel comfortable and understand the differences between the traditional synthetic HRT and Bio-Identical Hormones(BHRT). The WHI was not based on BHRT or physiological studies, it was based on synthetic, animal-derived, and traditional oral estrogens and progestins,” explains Dr. Rocco.
Hormone Replacement Therapy and Menopause
Postmenopausal women account for approximately 55 million people in the United States and 1.1 billion people worldwide. During menopause, a woman’s body no longer produces adequate amounts of the hormones estrogen and progesterone. According to Dr. Rocco, this drop in hormone levels can cause uncomfortable menopause symptoms, including hot flashes, night sweats, anxiety, depression, weight gain, difficulty sleeping, and difficulty losing weight. These symptoms can last for up to ten years after the start of menopause.
Hormone replacement therapy is used to relieve menopausal symptoms in women.
Generally, if a postmenopausal woman has a uterus, they will be prescribed a combination of estrogen and progesterone. This is because progesterone can help protect women with a uterus from endometrial cancer, which can form from estrogen-only therapy. If the woman no longer has a uterus due to a hysterectomy, then they will be prescribed estrogen only.
However, HRT isn’t appropriate for everyone and, according to Ms. Pelz, it shouldn’t be seen as a universal fix. “I sometimes work with clients who view hormone replacement as a cure-all, or something that can replace a healthy lifestyle—but that’s not the case! If you’re going through menopause, it’s more important than ever to keep up a healthy diet and lifestyle.”
Advantages and Disadvantages of Hormone Replacement Therapy
The most immediate advantage of HRT is relief from uncomfortable menopausal symptoms such as night sweats, hot flashes, insomnia, and vaginal dryness. Studies suggest that long-term hormone therapy can prevent bone fractures.
There is also evidence that HRT could help lower the risk of bowel cancer and prevent bone loss (osteoporosis).
As for disadvantages, research suggests that women on HRT have higher rates of blood clots, stroke, and breast cancer compared to women who are not on HRT. The risk of heart attack may also be slightly increased. In general, the longer a woman is on HRT, the greater the risk of grave side effects. Therefore, treatment should be for the shortest amount of time possible, using the lowest effective dose possible.
“Some disadvantages of taking HRT include the need to apply topical cream morning and night, which can be cumbersome, finding a qualified physician or clinician to prescribe and monitor it, and it can be pricey as insurance does not cover it,” notes Dr. Rocco.
Natural Alternatives to Hormone Replacement Therapy
For those who prefer not to take hormones, there are certain lifestyle changes and natural alternatives that may help alleviate menopausal symptoms. Exercise, eating a balanced diet, relaxation therapy, and yoga are all lifestyle changes that can help lessen the severity of menopausal symptoms. Avoiding potential triggers, such as caffeine, smoking, alcohol, and spicy foods, may also be beneficial.
“You’d be amazed by how much you can improve your hormone levels and ease menopause symptoms through lifestyle changes,” confirms Ms. Pelz.
As far as exercise, Ms. Pelz specifically recommends lifting weights and walking, explaining, “Weightlifting increases sex hormones, which is good for menopausal symptoms. But it does a lot more than that too. Muscle mass and bone density are two of the biggest predictors of quality of life as you age. Menopause decreases both of them—and lifting weights reverses those declines, ensuring you look and feel your best as you age. Also, walk every day.”
“It sounds basic, but research shows that low-level movement throughout the day makes a huge difference to both your hormone production and your overall health. I also think it’s one of the most underrated tools for weight loss. Aim for 10,000 steps a day if you can, but start with whatever’s possible. Even 1,000 steps a day will make a big change to how you feel if you’re consistent with it,” she adds.
Foods containing soy have been shown to alleviate menopause symptoms due to the way soy mimics estrogen in the body. Ms. Pelz also recommends that menopausal women reduce their sugar and refined carbohydrate intake, explaining, “They wreak havoc on your hormones and they’ll make you gain weight, which causes further hormone disruptions. Trade the dessert and simple carbs for complex carbs like squash, sweet potato, lentils, and beans. This is good advice for anyone, but it’s especially important during and after menopause.”
Dr. Rocco agrees that dietary changes can make a huge difference. She recommends a diet rich in vegetables, plant-based foods, and clean meats, as well as reducing one’s sugar intake to improve cardiovascular health. “Additionally, reducing alcohol intake is crucial as it affects hormones and increases cortisol production, leading to weight gain. Including more lentils and yams in the diet provides phytoestrogens which can naturally increase estrogen production,” she advises.
Finally, certain herbal remedies may also be helpful during menopause, including but not limited to:
- Black cohosh
- Red clover
- Evening primrose oil
- Lemon balm
- Fenugreek
- Fennel
- Ginkgo biloba
- Licorice
These herbal remedies can balance hormone levels and/or improve sleep, thus potentially alleviating menopause symptoms.
Dr. Rocco believes natural supplements can help menopausal women, specifically recommending green tea and DIM (diinodolylmethane) to help regulate hormones. “Taking vitamin D is beneficial as it improves the immune system and helps mitigate depression and anxiety linked to low vitamin D levels. Avoiding gummy vitamins is advisable due to their shorter half-life and sugar content,” she says.
It’s important to note that some herbal remedies can have serious interactions with certain medications, so always talk to your health care provider before taking any herbal remedies along with prescription or over-the-counter medications.
