Talk to your doctor about HRT
Why is it so challenging to address, and why is it still not commonly done? Many women suffer in silence and do not speak up.
Women often accept the downsides of "Change of Life," rarely considering the risks associated with staying silent about their symptoms. There are real concerns, such as increasing cardiovascular risks, osteoporosis, and dementia, that often go unaddressed. Why not explore hormone replacement therapy (HRT) and its potential role in reducing these risks?
Unfortunately, many doctors are still influenced by the 2002 Women’s Health Initiative (WHI) study, which led to a significant decline in the use of HRT among both doctors and patients. This study discouraged many women, particularly those in their late 40s and early 50s who could benefit from hormone replacement, from considering their options. Consequently, these women faced limited non-hormonal treatment alternatives. Both doctors and patients grew fearful of the reported increases in heart disease, stroke, blood clots and breast cancer associated with HRT. Many healthcare providers were hesitant to question the study’s findings and, as a result, refused to prescribe even low doses of estrogen or progesterone to patients in need. Additionally, providers often did not distinguish between bioidentical hormones and modified synthetic versions. Many studies referred to synthetic hormones simply as "estrogen or progesterone," rather than by their actual branded names. This led to misleading associations regarding the risks linked to original hormones—namely, human-form estradiol and progesterone—compared to the synthetic drugs studied. Furthermore, the WHI study had several limitations, including the patients’ ages, health conditions, and the timing of treatment initiation.
More than fifteen years later, as the limitations of the WHI study were revealed, doctors began to educate themselves and their patients all over again about the use of HRT. They started focusing on the timing and personalized approaches to treatment with sex hormones during menopause and perimenopause. More prescription options for “bioidentical” estradiol and progesterone became available and increasingly utilized. The transdermal route of administering estradiol gained preference, as it was shown not to pose the previously reported risks of breast cancer, strokes, or heart attacks.
Collaborating with doctors who are knowledgeable about the research data is crucial. While there are still many factors to consider before beginning hormone replacement therapy, both doctors and patients are increasingly questioning the reported risks and exploring the benefits of HRT. They are learning from the experiences of other providers while taking into account patients' needs and values.
More functional approaches to HRT have emerged, using compounded versions with personalized dosing and combinations of hormones. Pellet therapy has also gained popularity and is welcomed by many providers and patients. Both doctors and patients need to seek information, ask questions, and advocate for themselves. Women should discuss HRT with their physicians when the time is right. While mistakes were made in the past, we all must look forward, keep an open mind, and reconsider our previous beliefs and opinions as necessary. Women should not suffer in silence; they deserve to advocate for their health and well-being.
Please talk to your doctor about hormone replacement therapy and inquire about the available treatments, whether they are covered by insurance or not. Menopause should not lead to suffering; it is a time for women to express their symptoms and concerns to their doctors and seek the help they deserve.
