Menopausal Hormone Therapy

Myths and facts

Menopausal hormone therapy is the most effective treatment for hot flashes and genitourinary symptoms, according to the Menopause Society, and has been shown to prevent osteoporosis. But how risky are the hormones? The risks of hormone therapy depend on the type, dose, route of administration, timing of initiation and duration of use, the Society says.¹ Transdermal estrogen is safer than oral estrogen, especially with age.²

Here are some common myths and facts about menopausal hormone therapy.

Myth: Menopausal hormone therapy causes breast cancer.

Fact: The hormone formulation and route of administration make a difference. Bioidentical estrogen plus bioidentical progesterone, when used together, have not been found to increase breast cancer risk, according to large European studies.³ ⁴ Synthetic progestins are linked to a small increase in breast cancer. In the Women’s Health Initiative, horse-derived estrogens plus synthetic progestins led to nine additional breast cancers a year for every 10,000 women in their 50s. Factors that have a greater impact on breast cancer risk include alcohol, obesity and lack of exercise. It’s essential to get individualized advice from a health care provider and schedule regular mammograms.

Myth: Menopausal hormone therapy leads to weight gain.

Fact: Factors that cause midlife weight gain include decreased exercise, muscle loss, low estrogen levels and aging. Hormone therapy can have beneficial effects on preserving muscles mass, metabolic rate and insulin sensitivity as well as improving low estrogen levels. Lifestyle changes, with or without hormone therapy, can help avoid or assuage weight gain.

Myth: Menopausal hormone therapy causes heart disease.

Fact: Increased heart-disease risk is associated with oral estrogens and oral synthetic progestins. Women who start hormone therapy later than age 59, or more than 10 years after menopause, are also at increased cardiovascular risk. Conversely, the use of transdermal bioidentical estrogen and oral bioidentical progesterone is far safer; women who start these forms of hormones within 10 years of menopause may have improved cardiovascular outcomes. The benefits include improved blood vessel elasticity and function.

Myth: Menopausal hormone therapy contributes to dementia.

Fact: While oral synthetic hormones are linked to an increased rate of dementia, transdermal bioidentical estrogen and oral bioidentical progesterone are associated with decreased rates. Using the lowest effective dose of estrogen also lowers risk. These strategies may help prevent dementia. They are not, however, an effective treatment for Alzheimer’s disease.

Myth: Hormone treatment for all menopausal women is the same.

Fact: Treatment must be individualized for each person to maximize the benefits and minimize the risks. When hormones are used, they should be given at the lowest effective dose. The Menopause Society recommends regular follow-up visits, with periodic evaluations of the benefits and risks of continuing therapy.⁵ Integrative physicians often recommend monitoring with mammograms, cholesterol levels, and tests for markers of inflammation and hormone metabolism.

This newsletter is for educational purposes only. It is not intended as a substitute for medical advice or treatment; before adhering to any recommendations in this newsletter consult your healthcare provider.

1. The NAMS Position Statement: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf

2. Bioidentical (Natural) Hormones and Breast Cancer Risk. Virginia Hopkins Health Watch, 1-11-21. virginiahopkinshealthwatch.com/2021/01/bioidenticalbreastcancer/

3. A. Fournier, et al. Use of Different Postmenopausal Hormone Therapies and Risk of Histology—and hormone receptor-defined invasive breast cancer. Journal of Clinical Oncology, 3-10-2008. pubmed.ncbi.nlm.nih.gov/18323549/

4. Bioidentical (Natural) Hormones and Breast Cancer Risk. Virginia Hopkins Health Watch, 1-11-21. virginiahopkinshealthwatch.com/2021/01/bioidenticalbreastcancer/

5. The NAMS Position Statement: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf