HT Is Likely One of the Best Things You Can Do for Your Body in Menopause
That’s an honest-to-goodness fact! But, as with anything else we do—inside and outside our bodies— it isn’t right for every single one of us.
How and when to get HT, the type to get, and what’s going on with each of our unique bodies in the first place all influence how well it’ll work.
The sooner you learn the ins and outs of HT, the happier and healthier you’ll be in the long run. First, a little history of how hormones (wrongly) fell from grace.
Geri Brin, co-founder, M.D. For You
Illustrations by: Cé Marina
What Your Mother & Doctor Failed to Tell You
I could no longer conceive a child after my total hysterectomy in 1991. Sadly, that’s all I knew at age 44 about the consequences of the operation. So, when my surgeon at Langone NYU Medical gave me a prescription for an oral estrogen pill called Premarin, I dutifully filled it. I continued to fill it month after month, year after year, never questioning what the hormone was doing for my body.
My blissful ignorance was shattered a decade later by an alarming report warning women that hormone therapy increased our risk for breast cancer, heart attacks, stroke, and blood clots. I hot-footed it over to my doctor’s office for his advice. Without a moment’s hesitation, he told me to continue taking the Premarin. “Ignore the news,” I distinctly remember him saying.
I implicitly trusted the doctor’s advice and remained loyal to Premarin. But, the avalanche of media about the dangers of hormones terrified most gynecologists all over the globe, and they stopped prescribing hormones to their menopausal patients. Stopped cold. Practically overnight. They didn’t bother to take a deep dive into the actual study behind the news.
Calm, cool, and deeply informed about women’s health, my doctor didn’t trust the interpretation of the research, known as The Women’s Health Initiative. He was right, an unnerving fact that wouldn’t become public for another six years.
Making international headlines, the report summarized the outcomes of a long-term national health study testing the benefits and risks of special hormonal therapies on chronic diseases in postmenopausal women. Targeted illnesses included heart disease, breast and colorectal cancer, and osteoporosis, the major causes of death, disability, and frailty in older women of all races and backgrounds. Participants received either estrogen alone, estrogen +progestin or placebos.
The Hormone Travesty That Won't Quit Mistreating Us
Indeed, about two-thirds of the women participating in the study were past age 60, and had completed the menopause transition over a decade earlier. Waiting that long post menopause to start oral hormone replacement therapy (HRT) can, in fact, increase a woman’s risk for certain health issues.
The report simply didn’t address the benefits of HT for younger women who entered menopause naturally at the average age of 51, or surgically by hysterectomy in their 40s, as I had.
The study showed that the risks to women who start on hormones when they’re older dramatically outweigh the benefits to women who begin taking hormones when they’re younger. Yet, the report indicated that all women behaved with risk, said Dr. James Simon, co-founder of M.D. For You.
“All women were lumped together, which poisoned the well. If you put women aged 70 to 80 on the same medicine, at the same dose, as 50-year-olds, you can’t expect the same results,” he explained.
Dr. Simon believes the original analysis was intentionally false, especially about breast cancer. The study cost more than $600M, and the lead team felt it had to justify such a tremendous expense. They knew that the connection between hormones and breast cancer risk v. benefit was the most compelling argument, and wanted to make a splash for their expenditure, he said.
The amended analysis, released years later, told quite a different story: When a woman starts HR within six years of menopause, it can actually help protect her heart, breasts, and bones. Thank goodness, I hadn’t stopped taking Premarin. I am in my late seventies and have not had a single major health issue.
Before the study, estrogen-based therapy was routinely prescribed to effectively alleviate menopausal symptoms including hot flashes, sleeplessness, painful sex, and depression. It’s still FDA-approved and recommended by many esteemed professional societies for these purposes. Yet, less than 4% of menopausal women are on HT today.
High Time to Respect our Health Concerns
Distressingly, the medical community has failed over the last two decades to rectify the damage wrought by the skewed 2002 WHI report, and the intense fear of hormones it triggered. Fear morphed into apathy and neglect of the health of women in midlife. Medical schools give short shrift to the subject, and healthcare providers shrug off women’s menopause-related concerns as perfectly normal signs of aging.
And women are paying the price. Perturbing symptoms are curtailing our productivity at work; stealing the joy from outings with friends, and bringing new tensions to our marriages and motherhood.
Then there are health issues. Bone loss. Increased risk of heart attacks. Weight gain. Urinary tract infections. Brain fog.
During the decades before menopause, estrogen regulates our menstrual cycle and affects our reproductive tract, urinary tract, heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and brain.
Naturally decreasing estrogen in our bodies may be a fact of life, but where does that leave our organs when this vital hormone leaves the scene?
It’s well past time for the medical community to start respecting women’s health concerns once their child-bearing years have ended and finding the best treatments to help them.
Medical schools must add meaningful courses on midlife women’s health to their curriculum. And practicing physicians must learn about the impact of declining hormones in their patients’ bodies, and the options to mitigate it. HT is not the only alternative, but ignorance leaves doctors no other than walking away.
Proper education will help healthcare providers assess each woman’s risk exposure on hormone therapy. Anyone who prefers to remain ignorant—and fearful—of HT, rather than learning the nuanced truth, should stop seeing women in menopause. Discounting a woman’s symptoms as “natural” is not a treatment decision. It is negligence.
The Rise & Fall of Hormone Therapy - In Short
Analysis of a long-term national health study released in 2002 links hormone therapy to increased breast cancer risk
Prescriptions for estrogen-based therapy—routinely recommended to alleviate menopausal symptoms—drop precipitously throughout the world-wide health community
Fearful women stop renewing their prescriptions
Bombshell news announced years later. Results of the 2002 study were misreported—
skewed towards women well past menopause
Benefits of hormone therapy to younger women were intentionally ignored
Medical community fails to rectify damage wrought by initial report; only 4 percent of menopausal women receive hormone therapy in 2024
Mid age women are paying the price with untreated perturbing symptoms and major health issues, but that is changing as women become educated about their bodies
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