The Doctor is IN Menopause Mondays: Hormone Replacement Therapy (HRT) – Are You Still Confused? Dr. Josh Trutt Weighs in…
Well, the holidays are officially over. Many of us have spent the last week or so removing holiday decorations, and dreaming up how we can possibly lose the five-to-ten pounds we’ve accumulated thanks to a never-ending supply of eggnog and sugar cookies. (Ugghhhh….)
The end of the holidays signify a new beginning, and we’re often forced to confront issues that we may have been putting off. Is hormone replacement therapy (HRT) right for you? As if there wasn’t enough to be generally confused about leading up to and during menopause (the great hysterectomy debate, for example), there are still messy, muddled misconceptions surrounding the effectiveness and safety of hormone replacement therapy. That sucks! Feel as though you would like one, amazing doctor to sit you down and demystify the whole thing for you right here, right now? Well…you’re in luck! Dr. Josh Trutt, an expert from PhysioAge Medical Group in New York City, has been a guest on my blog before, and we love him. He’s back with some Q and A, and I for one, am a happy girl.
Ellen: Doctor, what would you say are some simple truths about hormone replacement therapy?
- Earlier is better. Starting HRT within ten years of menopause gives much greater benefit than starting later. In women who are younger than age 60, oral estrogens decrease the risk of both heart attack and stroke! In addition, starting HRT within eight years of menopause cuts your risk of Alzheimer’s disease in half.
- Using oral non-bioidentical estrogen (such as Premarin or ethinyl estradiol), at any age, will increase the risk of blood clots. When you swallow it, it gets metabolized in the liver, and increases the formation of clotting proteins. And using it together with fake, altered progestins increases the risk of clots even more. Using it in women with other risk factors for blood clots, such as obesity or smoking, raises the risk even further.
- Transdermal estrogen (meaning through a cream or a patch) does not increase the risk of blood clots, in either older or younger women.
- Oral estrogen that is started more than ten years after menopause is more likely to cause a stroke or heart attack in that first year after starting HRT. The reason is, estrogen protects women from building up plaque in their arteries. After menopause, estrogen is not being produced– so unless she goes on HRT, she will start building up plaque. Therefore, if a woman has had ten years without any estrogen, she will have built up significant plaque in her arteries. If she then starts oral estrogen, the plaque that has formed over starts to reorganize, and can become unstable in that first year, causing a heart attack or stroke.
- Synthetic, altered progestins like Provera (medroxyprogesterone), norethindrone, and norethisterone, all increase the risk of breast cancer slightly. Estrogen with natural, bioidentical progesterone does not increase the risk of breast cancer. Estrogen given alone for HRT actually decreases the risk of breast cancer.1
Ellen: The majority of women fear that HRT will cause breast cancer. Does it?
Dr. Trutt: The Danish Osteoporosis Prevention Study is a large, prospective, placebo controlled trial on HRT, and included over 1000 women who were within a few years of menopause.
These women were on HRT for ten years and were followed for 16 years total. None of the women had an increased incidence of breast cancer, and in fact, there was a decreased incidence in breast cancer for the women who used estrogen-only HRT. So, it would appear that there was no increased risk of breast cancer, or any other type of cancer.2
For more information about HRT and breast cancer, please visit Hormone Therapy and Breast Cancer: Clearing the Confusion and Fear by Marina Johnson, MD.
Ellen: The 2002 Women’s Health Initiative was a huge prospective trial of HRT. What were some general conclusions coming out of this study?
- For women who took oral estrogens but did NOT take Provera, the risk of breast cancer– in all age groups– went DOWN. That’s right: contrary to what you hear in the news, taking estrogen alone without Provera actually DECREASED the risk of breast cancer. In the WHI trial, and in many other trials like it, the fake, non-bioidentical altered version of progesterone (called “progestins”) is what caused a small increase in breast cancer. Estrogen does not. Estrogen with bioidentical progesterone also does not increase breast cancer risk.
- In the women who were younger than age 60, the risk of heart attack and stroke went down and their risk of “total death,” meaning death from any cause, went down.3
Ellen: Do “mainstream” docs agree with what you are saying?
Dr. Trutt: The Endocrine Society did a review of HRT in 2010. They were a very “mainstream” group of endocrinologists. Not all types of HRT are appropriate for all women, and they said that. But very importantly, they also pointed out that Menopausal Hormone Therapy was associated with a 40% reduction in mortality in women in trials in which participants had a mean age below 60 yr or were within 10 years of menopause onset,4 and that is exactly what they found in the Danish Osteoporosis study which was just released. Imagine finding a medication that lowers your risk of death by 40% for as long as you take it! That is what HRT offers when taken appropriately.
So, despite all of the misleading information out there regarding HRT, the conclusion that I have come to with Dr. Trutt is this: hormone replacement therapy is not a necessary evil; it is necessary and not evil. It is extremely important, however, to discuss exactly what type of HRT is right for you. That means you need to find a doctor who cares. Visit Menopause Mondays: Ellen’s 5 Steps to Hormone Happiness, Step 2: Find a Menopause Specialist.
For additional resources on hormone replacement therapy, see my other blogs on the topic at:
Remember: Reaching out is IN! Suffering in silence is OUT!
What steps are YOU going to take to determine whether or not HRT is right for you?
1 For more detailed information, visit http://truttmd.com/is-the-reporting-of-hrt-studies-a-war-on-women
2 For more information about the Danish Osteoporosis Prevention Study, visit http://www.bmj.com/content/345/bmj.e6409
3 For more detailed information, visit http://truttmd.com/is-the-reporting-of-hrt-studies-a-war-on-women
4 For more information about the above mentioned endocrine study, see Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement. JCEM July 1, 2010 vol. 95 no. 7 Supplement 1