Why the Controversy over the Use of Hormone Replacement Therapy for Menopause?

Learn what menopause is and why there’s such a hoopla over HRT therapy.

Sanaz Majd, MD
3-minute read

When estrogen levels drop during menopause, women just don’t feel well.  That is a fact.  I have never had a woman come into my office and tell me that she feels so much better now that she is experiencing menopause.  Never.  There may be a VERY select few who don’t feel very different, but no one ever tells me that sense of well-being actually improves.

What is Menopause?

I very often have women who come into my office to ask me for a blood test to see whether or not they are in menopause.  However, a blood test is not often diagnostic and can often be misleading.  In fact, the technical definition of menopause is one year without having a menstrual period.  That’s it.  That’s how you’ll know when you are officially menopausal.  Average age of menopause in the U.S. is 51--that means some women experience it before and some after.

In the several years before menopause, and up to ten years prior, women can start to sense the changes of what is called “perimenopause,” which can often continue to heighten until actual menopause.  During perimenopause, estrogen levels gradually decline.  And with the decline of estrogen, women eventually stop producing eggs and ovulating.  That is a normal physiologic process that is just a part of life. 

What are the Symptoms of Menopause?

When estrogen levels drop, our sense of well-being often drops too. Low estrogen can make us feel pretty crummy.  Here are some of the most common symptoms that women experience, even beginning as early as the late 30’s to early 40’s:

  • Hot flashes

  • Changes in mood

  • Depression

  • Fatigue

  • Vaginal dryness

  • Pain with intercourse

  • Infrequent or lighter menstrual periods

Why the Controversy Over Hormone Replacement Therapy (HRT)?

You may be wondering “Well, if low estrogen makes us feel so crummy, then why not just take estrogen?” That sounds like an easy enough fix, doesn’t it?

HRT, or hormone replacement therapy, refers to the treatment of menopause using hormones--estrogen and progesterone specifically.  And there is some controversy surrounding the use of it. Before 2002, it was a very common practice to prescribe hormones for many menopausal symptoms.  But when theWomen’s Health Initiative (WHI) study that included about 16,000 women on HRT came out in 2002, it changed the way doctors practice. The large study found that women on HRT had a very slightly increased risk of:

  • Heart disease

  • Stroke

  • Blood clots

  • Breast cancer

However, on the upside, women had a decreased risk of colon cancer and osteoporosis fractures (to learn more about how to prevent osteoporosis, listen to my previous osteoporosis podcast). 

Should Women Avoid Hormone Replacement Therapy?

We may need to take the results of the research study with a grain of salt, however.  The average age of women in the study was actually 63, which is way older than the age at which women begin experiencing symptoms of menopause.  So it may not be totally fair to compare younger women who are miserable and requesting a lifeline to save themselves from unrelenting hot flashes to those older women who participated in that study.

In addition, it is very rarely necessary to start HRT years after menopause has already occurred.  For most women, menopausal symptoms greatly improve or resolve after four to five years--even if they do nothing.  So nowadays, we may consider treating those super miserable patients with low risk of heart disease, blood clots, strokes, and breast cancer with low doses of HRT for as little time as necessary.    Of course, this is a conversation you will need to initiate with your own primary care doctor or gynecologist to see what is right for you personally.

Medical Disclaimer
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.

About the Author

Sanaz Majd, MD

Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women's health and patient education.