Is Hormone Replacement Therapy Safe?

by Dr. Jonathan D'Souza

Hormones play a vital role in every aspect of our health including the mood, digestion, cognitive function and heart health. Menopause is the time in a woman’s life when the ovaries stop producing an egg every four weeks, which stops her menstrual cycle or monthly period.

During menopause, the female hormones estrogen and progesterone drastically fall, causing a range of physical and emotional symptoms such as mood swings, hot flashes, vaginal dryness and concentration issues. Hormone replacement therapy (HRT) was developed with the aim of restoring female hormone levels during menopause to allow the body to function normally again.

How Safe Is Hormone Replacement Therapy
The Women’s Health Initiative (WHI) study of estrogen plus progestin vs placebo was stopped early, after about 5.5 years of follow-up, because the overall health risks of hormone therapy exceeded its benefits. The study done with 16,608 women found that women on hormone replacement therapy had a greater risk of fatal and nonfatal malignancies (tumors).[1]

While this study talked about how hormone replacement therapy can increase your risk of tumors, there is evidence that proves that it can have other side effects, too. We list some of the lesser-known side effects of hormone replacement therapy.

1) Increased Risk Of Stroke
The transition women experience during menopause is also the time when many women develop cardiovascular risk factors. In addition, during the 10 years after menopause, the risk of stroke roughly doubles in women. Stroke is the fourth leading cause of death and women account for 60 percent of all stroke events.[2]

However, the benefits and risks of hormone replacement therapy on stroke remains controversial. A study showed that hormone replacement therapy is associated with a 27 percent increased risk stroke incidence.[3]

2) Increased Risk Of Cardiovascular Disease
During menopausal transition, estrogen levels decline by 60 percent, leading to a relative androgen (male hormone) excess, that could contribute to the increased risk of cardiovascular disease in women. Cardiovascular disease is the most common cause of death in women.

Before the Women’s Health Initiative (WHI) hormone studies, it was believed that menopausal hormone treatment (MHT) protects against cardiovascular disease. However, the WHI study showed exactly the opposite. According to the study, women using hormone replacement therapy could be at a higher risk for developing cardiovascular disease than women who do not use the therapy.[2,4]

3) Increased Risk Of Breast Cancer
The Women’s Health Initiative study found a link between hormone replacement therapy and increased breast cancer risk. In a new study, researchers analyzed 1,642,824 screening mammograms with 9,300 breast cancer cases in postmenopausal women of 45 years or older, derived from the Breast Cancer Surveillance Consortium, a longitudinal registry of mammography screening in the United States.

The study showed that in women with low/normal BMI and extremely dense breasts, hormone replacement therapy was associated with a higher risk of breast cancer when compared with nonusers. The research also found that certain demographic groups (Caucasian, Hispanic and Asian) are at a higher risk of breast cancer after using hormone replacement therapy.[5]

4) Increased Risk Of Ovarian Cancer
Hormone replacement therapy may influence the growth of tumors after the onset of ovarian cancer. Estrogen and progestin could influence the growth of ovarian cancer tumors, an undesirable effect of the therapy.[6]

5) Increased Risk Of Blood Clots
Studies show that women using hormone replacement therapy have blood clots at a higher rate than those who don’t. Artificially altering hormone levels increases the thickness of blood, an action that tends to quicken the clotting mechanism.

Deep vein thrombosis (blood clot formed in one or more of the deep veins in your body, usually in your legs) and pulmonary embolism (blockage in one of the pulmonary arteries in your lungs caused by blood clots that travel to the lungs) are the most serious side effects and can be life-threatening.[7]

Dealing With Menopause Naturally
Here are some lifestyle changes you can make to deal with menopausal symptoms.

  1. Reduce your intake of caffeine, alcohol and spicy foods as they are known triggers for hot flashes.
  2. Stress can disturb the hormonal balance in your body and worsen signs of menopause. To avoid mood swings, make sure you get plenty of rest and exercise regularly. Meditative exercises such as yoga and tai chi can help you relax.
  3. Damage done to the blood vessels due to smoking can restrict blood flow and decrease the availability of oxygen in the body. Quitting smoking can help reduce hot flashes and decrease your risk of developing serious health conditions such as heart disease, cancer and stroke.
  4. Regular physical activities such as walking, jogging and cycling can improve blood circulation that can reduce hot flashes, improve sleep quality and boost your mood if you’re feeling depressed, anxious or irritated.
  5. Wear loose-fitting clothing and sleep in a cool, well-ventilated room to find relief from hot flashes and night sweats.

Advisory: The content made available at Z Living has not been evaluated by the Food and Drug Administration (FDA) or by any other governmental agency. It is for informational purposes only and is not intended to diagnose, treat, cure or prevent any disease.

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1. Heiss G, Wallace R, Anderson GL, Aragaki A, Beresford SA, Brzyski R, Chlebowski RT, Gass M, LaCroix A, Manson JE, Prentice RL, Rossouw J, Stefanick ML; WHI Investigators. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA. 2008 Mar 5;299(9):1036-45. doi: 10.1001/jama.299.9.1036. PubMed PMID: 18319414.

2. Lisabeth L, Bushnell C. Menopause and Stroke: An Epidemiologic Review. Lancet neurology. 2012;11(1):82-91. doi:10.1016/S1474-4422(11)70269-1.

3. Yang D, Li J, Yuan Z, Liu X. Effect of hormone replacement therapy on cardiovascular outcomes: a meta-analysis of randomized controlled trials. PLoS One. 2013 May 8;8(5):e62329. doi: 10.1371/journal.pone.0062329. Print 2013.
PubMed PMID: 23667467; PubMed Central PMCID: PMC3648543.

4. Harman SM. Menopausal hormone treatment cardiovascular disease: another look at an unresolved conundrum. Fertil Steril. 2014 Apr;101(4):887-97. doi: 10.1016/j.fertnstert.2014.02.042. Review. PubMed PMID: 24680648.

5. Hou N, Hong S, Wang W, Olopade OI, Dignam JJ, Huo D. Hormone replacement therapy and breast cancer: heterogeneous risks by race, weight, and breast density. J Natl Cancer Inst. 2013 Sep 18;105(18):1365-72. doi: 10.1093/jnci/djt207. Epub 2013 Sep 3. PubMed PMID: 24003037; PubMed Central PMCID: PMC3776262.

6. Hein A, Thiel FC, Bayer CM, Fasching PA, Häberle L, Lux MP, Renner SP, Jud SM, Schrauder MG, Müller A, Wachter D, Strehl J, Hartmann A, Beckmann MW, Rauh C. Hormone replacement therapy and prognosis in ovarian cancer patients. Eur J Cancer Prev. 2013 Jan;22(1):52-8. doi: 10.1097/CEJ.0b013e328355ec22. PubMed PMID: 22694828.

7. Ruszkowska B, Gadomska G, Bielis L, Gruszka M, Góralczyk B, Rość D, Odrowąż-Sypniewska G. Risk of venous thromboembolic disease in postmenopausal women taking oral or transdermal hormone replacement therapy. J Zhejiang Univ Sci B. 2011 Jan;12(1):12-7. doi: 10.1631/jzus.B1000106. PubMed PMID: 21194181; PubMed Central PMCID: PMC3017411.

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