Hormone Replacement Therapy: Risks & Benefits

More than 13 million women in the United States take hormones during and after menopause … to mitigate symptoms like hot flashes and stave off osteoporosis. No one knows for sure how many women abandoned hormone replacement therapy after studies from the National Institutes of Health questioned its safety. But one thing is clear, many woman are still confused about the research and conflicted about whether they should be taking hormones. Here’s a sampling of recent posts to a Yahoo message board on menopause.”I’m gathering info for my 75 year old grammy. She is concerned over the risks for Alzheimers disease, so she has stopped taking the HRT without consulting her doctor. Can anyone give me information on this?”

“I started on the estrogen patch in November and can’t live without it. I go nuts if I miss a day.”

“Stop — before you put one more poisonous pill in your mouth or smear it on your body.”

“I appreciate your response, but my quality of life was nil before starting on estrogen. I had anxiety thru the roof — I was ready to kill myself.”

Strong emotions that, like the experience of menopause itself, vary from woman to woman. It’s been said you cannot really understand “the change” until you go through it. Erica Rex, whose in her early 40’s, agrees.

“I know that hot flashes are something that it’s easy to minimize, if you’ve never had one. A hot flash is not something that feels like what happens if you walk into a sauna for a few seconds and then walk out. A hot flash comes on you as a sudden increase in body temperature. A tremendous spike. As it goes on, which can last quite a while, 10, 15, 20 minutes, you break into a sweat. My body gets incredibly weak to the point where I have to lie down or I probably will fall down.”

For Rex, staying on HRT’s, despite the risk, was a no-brainer.

“When I first heard that there were studies that came out, indicating that it might be a health risk I said to the person who told me about the studies and sent me the first one, my response to the friend was, compared to what exactly are these drugs now considered risky?”

Rex has been on hormones for four years, since having a total hysterectomy in her late 30s after a prolonged struggle with endometriosis. She says the stakes in not taking hormones were pretty high. It took her several years to find the right therapy and does. Those years of experimentation, going on and off hormones, wreaked havoc on her, making it impossible to do the things she loved most like riding horses and accomplish simple household tasks.

“I’m about to start cooking dinner here. That’s something I didn’t do for almost two years. I got so wiped out by the time John was getting home from work I was usually asleep.”

Rex’s husband, John, agrees there’s a big difference in the quality of life off, and now on, hormones.

“It was all pretty miserable there. Erica was miserable. Um, irritable. I was irritable. She went to doctor after doctor after doctor after doctor. Everybody had a different idea and, um, none of them seemed to work until now we’re on this formulated, isn’t that right? It’s called a compounded medicine // and now it’s a lot smoother. She seems in a lot better mood most of the time. And definitely seems a lot happier and a lot healthier.”

Erica Rex says it’s not easy making the decision to take hormones. It takes a lot of research into the risks of each type of hormone and a person’s own predisposition to those risks. Dr. Cora Lewis of the University of Alabama at Birmingham Division of Preventive Medicine conducted some of the research that questioned the safety of HRT’s. She says “risk” can be measured two ways.

“One is what they call a relative risk function and with that, we’re talking like a 30 to 50 percent increased risk in terms of breast cancer.”

The other thing to consider is absolute risk.

“That’s where you say for, okay, for every ten thousand women who take hormones for a one-year period, what ended up happening was there were eighteen more adverse events than we had expected among the people who were taking placebo. So eighteen out of ten thousand is, you know, a relatively small absolute risk increase, but it’s there.”

So, the risk of developing breast cancer for one individual woman on hormone replacement therapy is pretty small, but, Lewis says:

“If you multiply that over the millions and millions of women that were taking hormones that becomes a large public health burden.”

Lewis admits the clinical studies didn’t focus on women who were close to menopause, women who might still be experiencing hot flashes. She says while she wouldn’t suggest hormone replacement as a preventive measure to, for instance, prevent osteoporosis, she can understand why some women would choose to take hormones to deal with hotflashes and night sweats. Erica Rex says, in the end the decision was right for her.

“For me the decision was based on how I felt and how I functioned or didn’t function for so long. And in the end, I would rather have a slightly shorter life and have lived than lived till I’m 107 and most of the time felt horrible, not able to work, not been able to enjoy myself. And that’s a decision each of us gets to make.”