Menopause Series Part 2. Should I Be on HRT?

Menopause Series Part 2. Should I Be on HRT?

You know how it works….you’re on HRT for a few years and most women seem to try to wean themselves off it. Some succeed and find that they have no more menopausal symptoms after a few years on HRT. Others race back to continue as life feels unbearable without it. After some years, most GPs will try to get you off HRT due to all the risk factors involved.

So how long can you really be on HRT?

The short answers are….

  • Regular HRT- its complicated!

  • Bioidentical HRT- for life if it were up to me (and other like minded practitioners)

Regular HRT

Its complicated in this instance as HRT as a whole, have many beneficial effects, besides easing of common menopausal symptoms. It then becomes a decision where you have to weigh the benefits that it proffers versus the complications that it can give rise to. These ratios are interesting as when one looks at mortality charts, the biggest ‘scare’ ie breast cancer for most women using HRT. However, according to studies, the risk is only 0.08% for every year of use. This is in fact very low. This is then compounded by the WHI reports that stated that heart attacks went up by 29% and strokes by 41%. This is what was reported in the media and it sounds incredibly scary. But a breakdown of what these numbers actually mean is this:

  • 29% heart attacks: It means that per 10,000 person-years, there would be 37 women who used hormone therapy compared with 30 women who used placebo who would have a heart attack. 7 more women out of 10,000 in a year.

  • 41% strokes: 29 cases of stroke in the hormone group vs 21 in the placebo group per 10,000 person-years. Again, only 8 more women in 10,000. (2)

  • Of course these statistics still does not sound great but at least its not 41 out of 100 women or 29 out of 100 women- which is what we were led to believe!

However, it failed to take into account that a large number of people on the study ranged from 50 to 79 years, with a mean age at initial screening of 63.2 years. 66.6% of the women in the hormone group were between 60 and 79 years. It also failed to take into account that many of them had pre-existing diseases and were overweight (BMI>28.5) which would have made them not eligible for that particular hormone combination. Also, there is not a ‘one size fits all’ for hormone replacement in women. (2)

It also failed to highlight all the benefits HRT gives to these women. (1)

Let’s list the advantages

  • Better quality of life

  • 37% reduction in colon cancer (according to that study)

  • 34% decrease in hip fractures (according to that study)

  • Improved cognition and protects against Alzheimer’s disease

  • Improved balance

  • Improved skin

  • Decreased in urinary tract infection and degeneration

  • Better protection for heart disease and stroke (for the right patients when commenced at the right time)

  • Decrease in osteoporosis or thinning of the bone

  • Protects against cataract and macular degeneration

Very importantly, there is no acknowledgement of the fact that something quite contrary to what our bodies consider to be ‘self’ is being used- ie, a non bioidentical compound. In the WHI study, it was Prempro (0.625 mg conjugated equine oestrogens and 2.5 mg medroxyprogesterone acetate)- read- that is oestrogen from a pregnant mare. Why would or should we assume that our bodies will like them?

In summary, if you are on ‘regular’ HRT, please take the trouble to understand what you are taking. It has so many benefits, especially when started very early, when menopause first starts. If you have pre-existing diseases or habits eg obesity, smoking, family history etc, with the right practitioner and changes in lifestyle, its still very much a possibility to continue with HRT. At some point though, especially if its really making a difference to your lifestyle, bioidentical is always better.


  1. Women’s Health Initiative Study

  2. Why Individualizing Hormone Therapy Is Crucial: Putting the Results of the WHI Trial Into Perspective

  3. Vallée, Monique. “Neurosteroids and Potential Therapeutics: Focus on Pregnenolone.” The Journal of Steroid Biochemistry and Molecular Biology, vol. 160, 2016, pp. 78–87., doi:10.1016/j.jsbmb.2015.09.030.

  4. Murugan, S., Jakka, P., Namani, S., Mujumdar, V., & Radhakrishnan, G. (2019). The neurosteroid, pregnenolone promotes degradation of key proteins in the innate immune signalling to suppress inflammation. Journal of Biological Chemistry, jbc.RA118.005543. doi:10.1074/jbc.ra118.005543 

  5. Mayo, Willy, et al. “Pregnenolone Sulfate and Aging of Cognitive Functions: Behavioral, Neurochemical, and Morphological Investigations.” Hormones and Behavior, vol. 40, no. 2, 2001, pp. 215–217., doi:10.1006/hbeh.2001.1677.

  6. Takahashi MD, Traci and Kay Johnson MD. “Menopause.” Medical Clinics of North America. 99.3 (2015): 521-534.

  7. Al-Safi, Zain A., and Nanette Santoro. “Menopausal Hormone Therapy and Menopausal Symptoms.” Fertility and Sterility, vol. 101, no. 4, 2014, pp. 905–915., doi:10.1016/j.fertnstert.2014.02.032.

  8. Santoro, Nanette et al. “Menopausal Symptoms and Their Management.” Endocrinology and metabolism clinics of North America vol. 44,3 (2015): 497-515. doi:10.1016/j.ecl.2015.05.001

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