Does Hormone Replacement Therapy Harm or Help?

December 11, 2019

Hormones play a big role in how we develop, grow and how we feel. They are even part of how hungry we are and how we fall asleep at night. Like chemical messengers that travel throughout the body, hormones coordinate growth and metabolism and can influence the function of the immune system and alter behavior, according to the Cleveland Clinic. As we age, the levels of hormones released change; some will decrease and others increase.  For some women who are beginning menopause, changing levels of hormones may kick up some unpleasant side effects and lead them to seek relief for their symptoms.

A Changing Body
According to Dr. Anne Petit, obstetrician/gynecologist with Reliance Medical Group in Somers Point, the ovaries stop making estrogen, marking the end of a woman’s reproductive life. Some of the more common complaints associated with the onset of menopause are hot flashes or a sudden feeling of intense heat in the upper body and face. Some women may begin waking up at night, often due to night sweats. Changes in the vaginal and urinary tract due to mucosa thinning and drying results in discomfort and possible increased infections. Some women may also notice increased irritability or worsening moodiness.

Hormone Replacement Therapy (HRT)
There are two main types of HRT: an estrogen-only HRT and a combination HRT that contains both estrogen and progesterone. According to researcher Rama Knokha, PhD current or recent past users of hormonal replacement therapy have a higher risk of being diagnosed with breast cancer. Before the link between HRT use and breast cancer risk was established, many postmenopausal women took HRT for many years to ease menopausal symptoms like fatigue and irritability and to reduce bone loss. Since 2002, when research linked HRT and breast cancer, the number of women taking HRT has dropped significantly but many women continue to use HRT to handle bothersome menopausal symptoms.

HRT and Increased Breast Cancer Risk
The Lancet reported in September 2019 about the link between HRT use and breast cancer, indicating the risk of cancer was dependent upon the length of time the HRT was used and the age when it was started. Dr. Petit said there is a delicate balance between the use of HRT to manage menopausal symptoms and the potential risk of breast cancer.

“In my experience, women who come to the office seeking hormonal replacement therapy are aware of the potential risk of breast cancer. These women are often so physically or emotionally debilitated by the effects of the menopausal symptoms, they understand and accept any potential associated risks,” said Dr. Petit. She relayed stories of patients who have told her they have moments of wanting to kill somebody or had multiple episodes of hot flashes at night and that it was drastically affecting their life and the disruption of sleep worsened the moodiness. “Patients are given the information on the potential risks and they are maintained on the lowest dose and for the shortest time. For some patients, this restores the quality of their physical and sexual health,” according to Dr. Petit.

Weighing the Risks
Dr. Petit said there have been studies showing a correlation between prolonged estrogen exposure and a slightly increased risk of breast cancer. But she added, “In some situations, the patients may be so bothered by their menopausal symptoms that they desire continuation. In these situations, risk-benefit ratios are discussed with the patient as well as alternative modalities and a decision is made between the patient and the provider,” said Dr. Petit. She added that younger women who may have a need for HRT due to natural or surgical reasons may need to be maintained on HRT for a longer period of time but it is done so under close supervision.

Homeopathic Remedies

  • According to Dr. Petit, homeopathic and natural remedies are viable options for some women and may be effective in relieving their symptoms. Some of those homeopathic and natural alternatives include:
    • Black cohosh – helps with mood stabilization
    • Ginseng- helps with the occurrence and severity of hot flashes
    • Soy-contains isoflavones which is a type of plant-based estrogen
    • Vitamin E and flaxseed oil - used as a natural remedy for menopausal symptoms.

The physician cautioned women choosing the homeopathic or natural route.

“It is very important that women do their research because there can be interactions between the various remedies and also with any other medications they may take. Bioidentical hormones is another option some women choose, with the hormones made from plant based or soy derivatives and compounded in a lab. Bioidentical treatment is often not covered by insurance companies and is not FDA regulated,” said Dr. Petit. 

“Hormone replacement therapy is not for everyone,” said Dr. Petit. “But for some patients, it is everything. I often will recommend patients start the treatment with over-the-counter medications or with homeopathic regimens and for some patients that is sufficient. Some patients do not want to put any hormonal substance in their body and these patients are encouraged to try natural methods. But for the patient who is suffering with sometimes embarrassing hot flashes or is unable to sleep through the night because of night sweats, these are the patients who may benefit from hormonal treatment to help the transition to the menopausal state, and for these patients HRT may be an option.”

Dr. Anne Petit is an obstetrician/gynecologist with Reliance Medical Group in Somers Point.