There is a lot of information out there making women fearful regarding hormone replacement therapy (HRT). Many women are scared that its dangerous, particularly when it comes to estradiol, which is a form of estrogen. Much of this fear comes from 1 singular study from Women’s Health Initiative (WHI). This was a large clinical trial that made headlines in 2002. Over 20 years later, this information is still concerning women, although newer research has revealed that the WHI study had significant flaws, leading to widespread misconceptions about the risks of HRT. Since the 2002 study, many other well-designed studies have shown that when administered appropriately, HRT can actually reduce the risk of cardiovascular disease, stroke, dementia, and even breast cancer.
Let’s explore more regarding the WHI study. This study was designed to evaluate the risks and benefits of HRT in postmenopausal women. To fully understand the study and come to a conclusion, one must consider the factors that made the results misleading. The first factor to consider in this study is that the average age of participants was 63, meaning many women were well past the typical age of menopause onset. This is critical because starting HRT in younger, newly postmenopausal women has been shown to have very different effects, rather than starting it later. Another factor you must consider is that many participants had pre existing health conditions, including obesity, hypertension, and other risk factors that influenced the study’s ou comes. Most importantly, the WHI study used oral conjugated equine estrogens, not bioidentical estradiol, and medroxyprogesterone acetate, a synthetic progestin. These types of hormones have different effects on womens bodies than bioidentical hormones. The last factor to consider is that the WHI study grouped together all participants, failing to distinguish between women who had undergone hysterectomy, who received estrogen-only therapy, and those who took both estrogen and a synthetic progestin. There were so many flaws in this study, however, people still use it to incite fear surrounding HRT.
So what does the research really show? Since 2002, numerous studies have not only challenged, but also corrected the WHI study. These studies showed that HRT can be safe and beneficial for health. Below, we will explore the benefits of HRT according to each study.
- Cardiovascular Protection
- A Danish study (BMJ, 2012) followed 1,000 women within a few years of menopause. Those on HRT had a significantly lower risk of cardiovascular disease compared to those who did not take HRT. Even after stopping HRT due to WHI concerns, the benefits persisted for years.
- Another study (Climacteric, 2014) found that for healthy women aged 50-59, estrogen therapy decreased coronary heart disease and reduced all-cause mortality.
- Breast Cancer Risk: The Truth
- Contrary to popular belief, estrogen-alone therapy decreases the risk of breast cancer. A 2014 Climacteric study found that women who took estrogen-only HRT after hysterectomy had a lower risk of breast cancer compared to those who did not take HRT.
- The slight increase in breast cancer risk in some studies is associated with synthetic progestins, not bioidentical progesterone.
- Brain Health and Dementia
- Women who start estrogen therapy within ten years of menopause may have a lower risk of dementia, compared to those who do not receive HRT. (Climacteric, 2014).
- HRT appears to have a protective effect on cognitive function and may reduce the risk of Alzheimer’s disease.
- Stroke and Blood Clots: The Role of Transdermal Estradiol
- Unlike oral estrogens, transdermal estradiol does not increase the risk of blood clots or stroke (Climacteric, 2012).
- Bioidentical progesterone (as opposed to synthetic progestins) is also associated with a lower risk of clotting and breast cancer.
Exploring all of the studies listed above, the evidence overwhelmingly supports the early initiation of HRT. This means beginning HRT within the first ten years of menopause or before age 60 to maximize benefits and minimize risks. Women who are younger, healthy, and recently menopausal stand to gain the most in terms of heart health, bone protection, and cognitive function. It’s important to understand that the demonization of estradiol after menopause has been largely based on misinterpretations from the WHI study. Newer, more nuanced research has shown that HRT is safe and beneficial when used appropriately.
You can move forward confidently, knowing the following facts. Estrogen, for women without a uterus, reduces breast cancer risk. Transdermal estradiol is safer than oral estrogen in terms of stroke and blood clots. Bioidentical progesterone does not carry the same risks as synthetic. Cardiovascular disease risk and all-cause mortality decrease when HRT is started at the right time.
At Vytal Living Functional Medicine, we believe that women deserve accurate information about their health and bodies. If you’re considering HRT, talk to one of our providers. We understand the latest research, have years of experience administering hormones and helping women thrive. At Vytal Living, we take an evidence-based approach to all of our treatments, ensuring women receive the best care to support their long-term health and well-being. We’re located conveniently in Mt. Juliet, TN, just a short drive from Nashville, Franklin, Murfreesboro, Gallatin, or Hendersonville. Schedule a free consult with us today and experience the Vytal Living difference!