The Menopausal Hormone Therapy (HT) Controversy: Why Most Women Should Reconsider
For decades, hormone replacement therapy (HRT), now called Hormone Therapy (HT) has been a topic of heated debate, largely due to misleading conclusions from the 2002 Women’s Health Initiative (WHI) study. Many women, and even physicians, still hold outdated fears about the safety of HT, despite newer, more comprehensive research showing that HT offers significant benefits for most perimenopausal and postmenopausal women.
At Santa Fe Mobile MD, we are committed to providing evidence-based menopause care. Patricia Rosen, CNM, FNP, a board-certified menopause specialist with the Menopause Society (formerly the North American Menopause Society), offers expert guidance to help women navigate their options for HT in the comfort and privacy of your home.
The WHI Study: A Flawed and Misinterpreted Report
In 2002, the Women’s Health Initiative (WHI) study was abruptly halted due to concerns that HT increased the risk of breast cancer, heart disease, and stroke [WHI Study, 2002]. The media sensationalized the findings, causing millions of women to stop HT overnight. However, decades later, researchers have pointed out major flaws in the study:
Participants Were Older Than the Average Menopausal Woman
The average age of participants was 63, meaning most were already years past menopause, with existing cardiovascular risk factors.
HT benefits women who start therapy early, typically within 10 years of menopause [The Kronos Early Estrogen Prevention Study (KEEPS)].
The Study Used a One-Size-Fits-All Approach
The WHI primarily tested oral estrogen (Premarin) combined with synthetic progestin (Provera), rather than bioidentical hormones commonly used today.
Transdermal estradiol and micronized progesterone (now preferred) have a better safety profile [The ELITE Trial].
Absolute Risk vs. Relative Risk Confusion
The WHI reported a 26% increase in breast cancer risk, but this was a relative risk, meaning the actual increase was only 8 more cases per 10,000 women per year [Hodis & Mack, 2020].
Later analyses found no increased breast cancer risk with estrogen alone and only a minimal increase with estrogen plus progestin, with no increase in deaths attributable to breast cancer [The Lancet, 2019].
The Many Benefits of HT
Despite the fear surrounding Hormone Therapy, modern research overwhelmingly supports its benefits, particularly when started early in menopause.
Protects Against Osteoporosis and Fractures
Estrogen is critical for bone health, preventing osteoporosis and fractures.
Women on HT have 30-50% lower risk of hip and spine fractures [North American Menopause Society (NAMS), 2022].
Supports Heart Health
Narrowing and hardening of our blood vessels occurs within 10 years of the onset of menopause. Estrogen is important to keep blood vessels soft and dilated.
Women who start HT within 10 years of menopause have lower rates of heart disease and reduced arterial plaque, as well as reduction in all-cause mortality [Hodis & Mack, 2020].
Improves Brain Function and Reduces Dementia Risk
Estrogen helps maintain cognitive function and may reduce the risk of Alzheimer’s disease and other cognitive imparment if started early [Henderson, 2022].
Enhances Mood, Sleep, and Libido
HT can reduce depression, anxiety, and insomnia in perimenopausal women.
Many women experience better sleep and increased libido with HT [Soares, 2021].
Relieves Hot Flashes and Night Sweats
HT is the most effective treatment for vasomotor symptoms (hot flashes, night sweats, and chills) [NAMS, 2022].
Reduces Risk of Certain Cancers
HT significantly reduces a woman’s risk of colon cancer [Labadie et al., 2020]
Women using estrogen-only HT are about 20% less likely to be diagnosed with breast cancer compared to women not taking HT [Chlebowski et al., 2015].
NB: Combined hormone therapy using synthetic progestins, not micronized progesterone – the one we currently prescribe – is associated with a small increased risk of breast cancer, and women with a history of breast cancer should use non-hormonal therapies to alleviate menopause symptoms.
Reduced Risk of Diabetes
Large, randomized controlled trials suggest that menopausal hormone therapy (HT) using estrogens delays the onset of type 2 diabetes in women, by improving β-cell insulin secretion, glucose effectiveness, and insulin sensitivity [Mauvais-Jarvis et al., 2017]
Who Should Consider HT?
Most perimenopausal and postmenopausal women can benefit from HT, especially if they experience:
- Hot flashes and night sweats
- Sleep disturbances
- Brain fog and memory issues
- Mood swings, anxiety, or depression
- Joint pain or muscle stiffness
- Osteoporosis or fracture risk
- Vaginal dryness, frequent UTIs, or overactive bladder
However, each woman’s health profile is unique, and hormone therapy is not right for everyone. That’s why it’s critical to consult a menopause specialist to determine the safest and most effective HT option for you.
Meet Patricia Rosen, CNM, FNP, Your Santa Fe Menopause Specialist
At Santa Fe Mobile MD, we are proud to have Patricia Rosen, CNM, FNP, a board-certified menopause specialist with The Menopause Society, providing expert menopause care.
Why choose Patricia Rosen for menopause care?
Certified by The Menopause Society (formerly the North American Menopause Society)
Expert in bioidentical hormone therapy and individualized treatment plans
Offers at-home menopause consultations and HT management
Patricia is passionate about helping women navigate menopause with confidence and ensuring they receive the most up-to-date, evidence-based treatments.
Take Charge of Your Menopause Journey Today
The WHI study set back menopause care for decades, leading to unnecessary suffering for millions of women. Now, the science is clear: Hormone Therapy is safe and beneficial for most perimenopausal and postmenopausal women, particularly when started early. If you’re struggling with menopause symptoms, don’t wait. Contact Patricia Rosen at Santa Fe Mobile MD to explore your hormone therapy options and take control of your health today!
