HRT Safety

The next OsteoBoston Program will be held on Tuesday, July 9th featuring the highly regarded, Dr. Stephanie Osiecki who will be speaking on: "The Truth about Hormone Replacement Therapy in the Treatment of Osteoporosis". Don't miss this long awaited talk!

Join Zoom Meeting on TUESDAY, July 9th at 7 pm EST
https://zoom.us/j/98715019523?pwd=dGpBbUtwdTd0elpaUW5KVEs4ZnRNUT09
Meeting ID: 987 1501 9523
Passcode: 058259

@babs10 Thanks so much for posting this OsteoBoston Program I don't want to miss. As luck would have it, I'll be on a flight that day, but hopefully can watch it after.

@debbie1956, They record and repost soon within a week of their presentations so you will definitely be able to watch it after the fact! 🙂

http://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf

Interesting that if started after age 65, HRT increases the risk of dementia. I would not have thought...

As a person who had breast cancer fed by estrogen and progesterone, I am mystified by the 1 in 1,000 statistic for women on HRT who get breast cancer. One in 8 women get breast cancer and 80% of those are driven by hormones. I guess the key is not to use it too long:

" Hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than 4 to 5 years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at 7 years but may increase risk if used for a longer time."

@babs10 thank you for the link.

This menonote is dated 2017. I wonder what clinical trial results it is based on. To me, it appears to be a blend of some of the conclusions of WHI studies with some contemporary views/practices.

The topic of HRT is very confusing to say the least. To start, an understanding of WHI study design and its results/conclusion is a must. CEE and MPA are no longer the predominant meds. The newer formulation (E2 +/- micronized progesterone) and different route of administration beg for good, large scale RCTs so more women could benefit from hormone therapy, for whatever their needs might be. When drawing our own statements, opinions or conclusions, we have to consider the following:

-the age at which hrt is started
-how long hrt is used
-formulation of estrogen (mainly E2 vs CEE)
-formulation of progestin (mainly micronized progesterone vs synthetic medroxyprogesterone)
-estrogen alone or in combo with progestin
-route of administration
-dose variation
- the cohort of a RCT

For the newer formulation, there are KEEPS and ELITE studies which made some preliminary conclusions regarding cardiovascular risks. Good studies are few and far between regarding different risks associated with new formulation, and in different cohorts of women. So @windyshore, I wouldn't let the dementia risk mentioned in this particular menonote bother me. Let's find most recent reputable RCTs and let the results speak in detail. As for breast cancer risk, it is also complicated... in general, docs don't recommend hrt therapy to someone who has history, or family history of breast cancer.

@mayblin none of the details bother me. HRT is out of the question for me with my history of grade 3 hormonal breast cancer.

The thing I don't understand is, that at some point we all have to go through menopausal symptoms. Then for many of us they calm down. I would rather go through that at 50 than 65, I guess. I get that people are interested in keeping bone density but perhaps SERMS should be used more-?

@babs10 A certified practitioner/naturopath through the N.A. Menopause Society I recently consulted suggested this podcast by Dr. Streicher's Inside Information-Hormone therapy after age 60 with Dr. James Simon (April 10,2024): . https://audioboom.com/posts/8488754-hormone-therapy-after-age-60-with-dr-james-simon

Hi @debbie1956 thank you very much for posting this podcast link. It summarizes the current view/approaches well, especially for those of us who are 10 years past menopause. The “timing hypothesis” has been discussed here and there are published papers available on this topic.

Regarding cardiovascular risk related to HRT use, there is an article I came across by Cleveland Clinic worth reading:
https://consultqd.clevelandclinic.org/menopausal-hormone-therapy-and-heart-risk-updated-guidance-is-at-hand
In this article, the risks were stratified to 3 categories:

“In keeping with the guidelines from the four medical societies, the ACC committee advises cardiologists to take a risk-stratified approach to HT, as follows:

Treatment is low-risk in women with recent menopause, normal weight and normal blood pressure who are physically active and have a 10-year atherosclerotic cardiovascular disease (ASCVD) risk < 5% as well as a low risk for breast cancer.
Treatment is intermediate-risk in women who have one or more of several risk factors (diabetes, smoking, hypertension, obesity, sedentary lifestyle or limited mobility, autoimmune disease, hyperlipidemia, metabolic syndrome) and those who have a 10-year ASCVD risk from 5% to 10% or are at high risk for breast cancer.
Treatment is high-risk in women who have congenital heart disease, ASCVD or coronary/peripheral artery disease, venous thromboembolism (VTE) or pulmonary embolism, stroke/transient ischemic attack or myocardial infarction, breast cancer or a 10-year ASCVD risk ≥ 10%.”

The article also provided a link for an in depth review by Dr. Leslie Cho, a Cleveland clinic cardiologist.

I was under the care of my current cardiologist for 3 years then sought a second opinion of a cardiologist who specializes women’s heart recently. They both concluded that HRT is suitable for me as far as cvd risk is considered, even though I had a cac score of 38. I had numerous tests done and labs are followed closely for the past 3 years. The cardiology specialist wanted the target for my LDL-c below 55 and HbA1c below 5.6, a stricter target than the one I previously followed. Now looking at the stratified category, I realize I’m between low and intermediate risk. Maybe that’s why the specialist adjusted target bio parameters lower.

Hope this article is helpful to someone seeking cvd risk related information.

Wish you a smooth process going forward, and that HRT works for your needs!

Great information from everyone. One question. Assuming a woman 15 yrs post menopause is in the low to intermediate risk category and goes on hrt. Is she on hormones for the rest of her life? or tested every year to determine when to come off? When she stops hrt does she go through the same symptoms as menopause?