Hormone Replacement Therapy: Friend or Foe?

There have been a number of storms in a variety of tea cups when it comes to hormone therapy and what the best course of action is.

In case you hadn’t noticed, Hormone Replacement Therapy (HRT) is having quite the moment. Or perhaps it would be more accurate to call it a comeback.

HRT gained mass popularity in the nineties and was heralded as the wonder option for all things menopausal. Women were raving about how hormone therapy had eased their insomnia, aching joints, and hot flashes, as well as helping them get their zest for life back.

Then, in 2002, the U.S. Women's Health Initiative (WHI) abruptly halted a study into HRT as the researchers had identified an increase in breast cancer, and heart disease, from those using combination HRT (estrogen plus progestin).

Despite the fact that two thirds of the study group was between 60-79 years old, and the study itself was designed to assess possible HRT and heart health associations for women who were not in peak menopause, the media ran with the “breast cancer link” headlines and many women ditched HRT overnight.

Subsequently, new guidelines were issued in the US, UK and Australia that encouraged low doses of HRT for a shorter period of time. Furthermore, it was recommended that women with a personal or family history of breast cancer should avoid HRT altogether.

Fast forward a decade or two and the WHI study is being challenged by medical professionals such as Dr. Louise Newson who question its validity and who instead champion the benefits of HRT and the quality of life it can restore for many women.

As more concerns have been raised about the initial interpretations of the WHI study (including the fact that women in their 50s were underrepresented as part of it), the panic that caused women to stop taking hormone therapy back in 2002 has since turned to anger that they’d been led to believe there was a notable threat to their health in the first place.

HRT is seemingly no longer the demon, but once again the savior.

However, Dr. Newson herself recently came under fire for apparently over-prescribing hormones beyond the recommended level of what’s currently considered to be safe.

There have also been a number of heated debates as to whether exercise alone might really be the answer to naturally balancing our hormones.

In short, there have been a number of storms in a variety of tea cups when it comes to hormone therapy and what the best course of action is.

But between the outrage and the overwhelming amount of mixed opinions, the one clear message is this: We are not all having the same experience.

Some women sail through menopause with minimal disruption to their lives. Some women feel as though their bodies are complete strangers and that their sanity is slipping away from them. Some women love exercise and embrace movement as part of their self-care regime. Some women experience chronic pain or fatigue and don’t have the capacity required for high intensity work outs.

There is no universal “right” way to experience perimenopause or menopause.

When we determine that there’s only one acceptable solution to support women though this stage of our lives, we’re neglecting to recognize the intersections of each experience and we’re limiting the options that might be available to us.

What if both HRT and exercise are simply part of a wide range of possible choices we might opt to make? What if we stop announcing (or denouncing) a single solution for every woman’s needs?

No two bodies are entirely identical. One persons menopause success story could well be another persons awful experience. Adopting a “one size fits all” approach to how we navigate our hormones sounds a lot like the patriarchy speaking.

But at least we’re making headlines, right? Unlike the generations of women who came before us and had to suffer through menopause in staunch silence, or speak of it only to close friends in hushed tones, we’re finally bringing menopause into the spotlight. Surely that’s a step in the right direction?

Well, yes and no.

Contrary to the popular saying, not all publicity is good publicity. For every useful article shared, there’s at least double the amount of targeted ads and dubious promises plastered across social media assuring us that we simply need to drink this tea or take that pill in order to free ourselves from meno-belly and meno-rage (terms most definitely not coined by me).

1 billion women worldwide are expected to be in menopause by 2025. The global menopause market size is expected to reach USD 22.7 billion by 2028, with dietary supplements leading the way.

Having access to a big platform or thousands of social media followers does not qualify someone to offer medical advice to the masses. There’s a worrying amount of misinformation out there regarding treatments for menopause and it can feel like somewhat of a minefield trying to make sense of it all.

The only thing we can really be sure of is that advocating for ourselves is our best hope of having a smoother transition through menopause. Especially when many doctors still don’t receive adequate training specific to menopause and subsequently often misdiagnose symptoms. It’s common for women to be offered anti-depressants or anxiety medications as an automatic response to individual symptoms without doctors recognizing that hormonal disruption could be the root cause.

Having had my own experience of being dismissed by my doctor and told I was “too young” to be in perimenopause at 44, I realized that in order for me to be taken seriously and ensure that I had access to the support I needed, it was imperative that I did my own research and came armed accordingly to future appointments.

Keeping track of symptoms is hugely helpful in recognizing any patterns, particularly when many women experience multiple symptoms simultaneously. It’s also useful to seek out health professionals who specialize in providing care through perimenopause and beyond.

As those of you who read my last post will know, I’m currently experiencing a pretty dire time in peri/menopause. My symptoms have gone from being somewhat annoying and inconvenient to interfering with my day to day life in a way that doesn’t feel sustainable. My anxiety is at an all time high and I’m actively seeking solutions.

HRT was something I considered to be a possible future option that I’d likely explore when the time was right. But since my symptoms have become more intense, that “future option” now very much feels like a present need.

That said, I favor a holistic approach when it comes to my health. In my experience, a combination of different treatments and therapies tend to yield the best results. I don’t expect HRT to be a magic wand. That’s why I’ve been incorporating much more consistency when it comes to nutrition, hydration, movement and meditation. Supporting my system with those things alone hasn’t erased my symptoms, but I do feel so much better simply for being proactive and taking a broader view on what my body might need.

As far as HRT safety is concerned, I take any possible links to breast cancer very seriously. My mother had breast cancer twice and I’ve had my own scares with regards to clusters of calcifications that have required further investigation.

Right now the North American Menopause Society says the benefit-risk ratio of hormone therapy appears favorable, although this can differ for women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed.

It’s important to remember that data and research are always developing. The information we have available to us today is different to what we had access to 10 or 20 years ago. It will almost certainly be different another 5 or 10 years from now.

I plan to see a menopause specialist to get personalized support that will take into account my medical history, my current symptoms, and the latest research. Any decisions I make with regards to treatment will need to be reviewed as I move further into menopause and/or recommendations change.

If one thing is for certain, menopause is a fluid and evolving experience, so it makes sense that our choices are, too.

How do you feel about HRT? Is it something you’re already taking, or something you’re considering?