Estrogen hormone therapy: Weighing the risks and benefits


Women approaching menopause may wonder if hormone replacement therapy (HRT) will be necessary or right for them. At one time, estrogen HRT was routinely used to treat menopausal symptoms believing it had a protective effect on women’s long-term health. In past years, it was not uncommon for almost every woman going through menopause to be prescribed estrogen or estrogen combined with progestin, both female hormones to help relieve hot flashes, vaginal dryness, insomnia, and other menopausal symptoms.

But in recent years, scientific research began to question the automatic HRT for menopause and if all women needed it, and were there serious health ramifications from using it?

Types of estrogen hormone therapy

The purpose of HRT is to help replace the body’s natural production of estrogen a woman’s body no longer makes after menopause. Menopause usually occurs naturally in women between ages of 45 and 55. It is natural for estrogen levels to decline to start around menopause and is a normal stage in a woman’s life that typifies the end of her reproductive cycles. As menopause approaches, the ovaries gradually produce less estrogen (a female hormone), causing changes in the menstrual cycle and other physical changes.

Unfortunately, this decline can result in unpleasant symptoms that women seek relief from – hot flashes, vaginal dryness, mood changes, and to reduce the risk of developing cardiovascular disease.

There are two types of estrogen HRT:

  1. Systemic hormone therapy: Used to treat common symptoms of menopause, this type has a higher dose of estrogen available in a pill, skin patch, ring, gel, cream, or spray form and is meant to be absorbed throughout the body.
  2. Low-dose vaginal products: This type of HRT is meant to only treat vaginal and urinary symptoms of menopause. The amount of estrogen absorbed in the body is less than what systemic hormone therapy provides and is available in a cream, tablet, or ring form.

Women who still have their uterus are typically prescribed estrogen along with progesterone or progestin which is a progesterone-like medication.

Risks of HRT

Over the years, menopause had gotten to a point where it was seen as a condition that needed treatment with medications. However, in 2002, a landmark study called the Women’s Health Initiative discovered that the most commonly prescribed HRT was increasing women’s risk for the following conditions:

  • Heart disease
  • Heart attacks
  • Stroke
  • Blood clots
  • Breast cancer

After this finding, a warning label of the potential heart risks from estrogen therapy was mandated by the FDA and soon after, prescriptions for HRT for women, sharply dropped.

Since then, subsequent studies have found that the risks to a woman’s health depended on several factors:

  • Women who started HRT at age 60 or older or more than 10 years from the onset of menopause were at a greater risk. Women, who were prescribed HRT before the age of 60 or within 10 years of menopause, had reduced risks of the above conditions.
  • Risks to women’s health depended on whether estrogen was given alone or with progestin, the dosage prescribed, and the type of estrogen provided.
  • A woman’s health history (family and personal) and her risk of cancer, heart disease, stroke, blood clots, liver disease, and osteoporosis were other factors healthcare providers needed to take into consideration of which HRT is right for each individual woman.

Benefits of HRT

While a good majority of women likely will not need HRT during or after menopause, some women can and will benefit from it. If a woman is healthy, is younger than 60 with less than 10 years from her onset of menopause, and has no family or personal history of cancer, heart disease, liver disease, or osteoporosis, she may find some advantages to taking HRT is she has the following issues:

  • Is having moderate to severe hot flashes
  • Has other symptoms of menopause such as vaginal dryness, itching, burning, and discomfort with intercourse
  • Is experiencing early menopause or has estrogen deficiency. Women who’ve had their ovaries surgically removed before age 45 or have stopped menstruating before age 45 or have lost normal functioning of the ovaries before age 40, will have been exposed to less estrogen than women who go through menopause at an older age. HRT can help these women by reducing their risk of heart disease, stroke, dementia, and mood changes.

Bottom line

Estrogen HRT is not all good or all bad. The best way for women to know if HRT is right for them is to discuss it with their doctor. Begin the conversation by discussing symptoms they are having and their family/personal health risks, in order to help their doctor determine if HRT is a good treatment option or not and if so, what type and dosage to safely take. Even after a woman has gone through menopause, she should always inform her doctor about any new changes or symptoms she notices.

Estrogen hormone therapy: Weighing the risks and benefits
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Dr. David Samadi

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Dr. David Samadi