Daniel A. Monti, director of the Myrna Brind Center of Integrative Medicine at Thomas Jefferson University Hospital, answers five confusing questions
July 19, 2010
If you conduct an internet search for Hormone Replacement Therapy (HRT), you’ll see reams of information that is supposedly intended to help women determine if HRT is “right” for them. From medical journals and health care institutions, to the government and even Oprah, everyone seems to have an opinion on HRT. But there are so many inconsistencies and biased statements that it is a challenge for the average woman to make an informed decision. The answers to the following five questions are what I think every woman should know prior to discussing the matter further with her physician.
1) What is Hormone Replacement Therapy (HRT) and what does it treat?
Let’s start with the basics. First, although there are numerous hormones in the body, HRT generally refers to replenishing the ones made by the sex glands (ovaries for women; testes for men), which include estrogen, progesterone, and testosterone. The production of these hormones declines with age, which can create symptoms. The decline starts around age 40 and can continue for up to a couple of decades, culminating in menopause. Not every woman struggles with menopausal or perimenopausal symptoms, but those who do often complain of the following:
• Hot flashes
• Poor sleep patterns
• Diminished Libido
• Mood fluctuations
• Low energy
HRT has been shown to dramatically improve these symptoms. In addition, women can notice diminished bone density – osteopenia and osteoporosis – which also can be improved with HRT.
2) Why is there controversy about HRT?
By the year 2000, over 10 million U.S. women were taking synthetic estrogen – most often Premarin, or Premarin in combination with progestin (a synthetic form of progesterone), under the brand name PREMPRO.
In 2002, the first large-scale study of HRT, called the “Women’s Health Initiative (WHI)”, found that women who were taking PREMPRO had an increased risk for heart disease, blood clots, breast cancer and stroke. The results were so overwhelming that the study was prematurely terminated. A second study, the Heart Estrogen Progestin Replacement Study (HERS Study), showed that women who had a previous cardiovascular event had increased risk of having a second one if they were taking synthetic HRT.
Results of these two studies threw the HRT industry into a tailspin, causing millions of women to be taken abruptly off of Premarin and PREMPRO with nowhere to turn. Fortunately, there are now several other options available for the informed patient.