Mooney & Berry Gynecologists
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Risks and Benefits of HRT

Risks and Benefits of HRT

 

Risks, Benefits, Side Effects and Contraindications of HRT

ESTROGEN:

The risks and benefits of Estradiol vary according to age, medical history, dosage, duration of use, and formulation of the hormones [oral vs transdermal] Risk benefit analysis of HRT is an inexact and ever evolving science. Most importantly, only the AVERAGE risk and benefit over large numbers of people can be calculated, therefore it is impossible to say who will or wont experience that risk. To that individual, the risk is 100%.

CONTRAINDICATIONS:

  • Breast Cancer

  • Uterine Cancer

  • Undiagnosed abnormal uterine bleeding

  • History of Blood clot in leg or Lung

  • History of stroke or Heart Attack

  • Active Liver Disease

  • Allergy to Estrogen

BENEFITS:

QUALITY OF LIFE: Estrogen reduces or eliminates the following symptoms:

  • Hot Flashes

  • Night Sweats

  • Dry Vagina

  • Insomnia

  • Painful Sex

  • Mood Swings and Irritability not due to other causes

  • Depression

  • Urogenital Syndrome of Menopause [increased urinary frequency, urgency and bladder infections along with dry vagina, burning and painful sex.]

MEDICAL BENEFITS:

  • Decreased hip fractures

  • Decreased risk of colon cancer

  • Decreased risk of type II diabetes

  • Decreased risks of Cataracts

  • Decreased risk of osteoarthritis

  • Decreased loss of teeth

SIDE EFFECTS OF ESTROGEN:

Common:

  • Fluid retention

  • Headaches

  • Breast soreness

  • Menstrual bleeding

  • Weight gain can be due to fluid retention or to the normal progression of weight gain seen after menopause with or without hormones. It is unlikely that hormone therapy by itself increases weight in the average patient who takes HRT.

Uncommon:

  • Elevated blood pressure.

  • Abdominal pain

  • Dry eyes [rare]

RISKS OF ESTROGEN:

The risks of Estrogen are highly dependent on one’s age, the formulation (transdermals lower risks), and whether synthetic Progesterone is taken along with Estrogen (increases risks).

SPECIFIC RISKS:

OVER 60:

  • Heart attack, stroke, breast cancer and blood clots in lung are all slightly increased [1/1000 chance of each per year]. However, the lowered risk of colon cancer, hip fractures from osteoporosis and possibly other benefits keep the NET chance of death the same.

  • Women over 60 who take natural progesterone, along with estrogen do not have an increased risk of breast cancer, and their risks of stroke and heart attacks are less as well. Their risk of blood clots in the lung is still elevated.

UNDER 60:

  • Oral Estrogen only users: slight increase in risk of blood clot to lung. Slight decrease risk of stroke, breast cancer, heart attack, colon cancer and hip fractures. If transdermal estrogen is used, there is no increase in the risk of blood clots in the lung, and the other benefits remain unchanged.

  • Oral Estrogen plus synthetic progesterone users: Slightly higher risks of stroke heart attack breast cancer and blood clot on lung, but lower than over 60 risk. Natural progesterone does not appear to increase these risks according to recent large scale studies. Lower risk of colon cancer, hip fractures and overall chance of death from all medical causes are found in women who take HRT compared to non users.

ESTROGEN DOES NOT INCREASE ONE OVERALL RISK OF MORTALITY

Women under 60 who take hormones have a LOWER overall risk of death from all medical causes than those who don't. This lowered risk is small but statistically significant. This is thought to be due primarily to the cardio-protective [heart healthy] effects of estrogen.

Women over 60 who take hormones have the same overall mortality as those who don’t. However, their risk of heart disease and stroke are actually higher than non users. This is thought to be due to the fact that they have already developed some degree of atherosclerosis [fat and calcium deposits]. Oral estrogen increases the risk of these deposits clotting clotting and blocking blood flow to those areas. Transdermal estrogen [patches, gels and creams] and natural progesterone, if needed, consistently show the lowest risks of HRT regardless of age.

OTHER POTENTIAL RISKS OF HRT:

  • Cancer of the uterus is a major risk factor for estrogen alone therapy. However, the addition of progesterone nullifies this increased risk and should always be used alongside estrogen in postmenopausal women.

  • Ovarian cancer has been studied with mixed results. Long term use of birth control pills actually decreases ovarian cancer risk by 50%. A tiny but not statistically significant increased risk of ovarian cancer may be associated with HRT.

  • Alzheimers dementia is another controversial risk/benefit factor like heart disease. Estrogen therapy may decrease the risk if started early but increase the risk if started at ages 65 and older. The risks of developing the disease due to HRT are slight [less than 1 in 2000 per year.]

  • Gallbladder disease may be slightly increased in HRT users FDA vs Non FDA approved BHRT

  • Lupus: increased risk of developing the disease or exacerbating existing condition

BIOIDENTICAL BHRT AND THE FDA

BIOIDENTICAL PROGESTERONE AND ESTRADIOL ARE FDA APPROVED IN PROPRIETARY FORMULATIONS. These include tablets, patches sprays gels and vaginal preparations. BIOIDENTICAL ESTRADIOL and TESTOSTERONE formulations including pellets, injections and various compounded creams have NOT been evaluated in such large scale studies as those used to determine the above referenced statistics and ARE NOT APPROVED FOR USE BY THE FDA. However, they are allowed to be used “off label” and have been in use for over 50 years. Numerous smaller scale studies appear to support their relative safety. It is our belief based on extensive personal experience, the available studies, and the long term usage, that BHRT is a reasonably safe alternative especially when FDA approved hormones are ineffective or unaffordable.

BIOIDENTICAL PROGESTERONE AND ESTRADIOL HAVE BEEN APPROVED IN PROPRIETARY FORMULATIONS.

These include tablets, patches sprays gels and vaginal preparations.Recent large scale studies demonstrate NO increase in breast cancer and NO adverse changes in cholesterol that appear to cause the increased risk of cardiovascular disease seen with synthetic progesterones. Therefore we recommend it as first choice in women who need protection from the increased risk of uterine cancer seen with unopposed estrogen use.

TESTOSTERONE:

CONTRAINDICATIONS:

Allergy to testosterone or any of the components of the formulation active heart, liver, or kidney disease

BENEFITS:

  • Increased Libido

  • Increase preservation of muscle mass

  • Increase bone Strength especially combined with estrogen

  • Increase sense of well-being

  • Increased exercise capacity

  • Decrease in muscle and joint pains especially when used with estrogen may have beneficial effects on heart

RISKS AND SIDE EFFECTS OF TESTOSTERONE:

  • Acne and facial hair thickening or darkening occur in 10% of patients; this can be improved by lowering dosage.

  • Scalp Hair loss is less common and is usually reversible

  • Lowering of voice and enlargement of clitoris are very uncommon and reversible.

  • Polycythemia [thickening of blood]

  • Aggressive and irritable mood

  • Liver cancer and other serious life threatening conditions are associated with high dosages of synthetic steroids abused by athletes or body builders. These serious side effects have not been shown to be significantly increased by replacement doses of bioidentical testosterone.

PROGESTERONE:

Natural [bioidentical] Progesterone is generally considered to be safe. Oral and transvaginal preparations are approved by the FDA.

Benefits:

  • Improve sleep

  • Protect against uterine cancer in estrogen users

  • Side effects:

  • Drowsiness

  • Breast soreness

  • Fluid retention

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.