Menopause is not for the faint of heart. Hot flashes, night sweats, brain fog, and the emotional rollercoaster that makes you cry over a commercial...again? It’s a full-body transformation that can impact your health, career, relationships, and maybe your favorite white t-shirt thanks to those surprise sweats.
You’ve tried the herbal teas. You’ve tried the supplements. You’ve even tried sleeping with the AC set to arctic tundra. But if you're still not feeling like yourself, it's time to talk about hormone replacement therapy - without the outdated fear tactics.
Why Are So Many Women Afraid of HRT?
Let’s rewind to 2002. The Women’s Health Initiative (WHI) published a study linking combined estrogen and progestin therapy to an increased risk of breast cancer, heart disease, stroke, and blood clots (1). Panic ensued. Medical providers (myself included at one point) were trained to warn women off HRT faster than you could say “hot flash.”
The fallout? An 80% drop in HRT prescriptions nationwide (2). Cue decades of women white-knuckling through menopause because they were told it was safer to suffer.
But here’s the thing: that study? It had some major flaws. Most of the participants were older (think 60+), many were already at risk for heart disease, and the study used one formulation, one route of administration, and one type of hormone.
Since then, the science has evolved, and it’s time our conversations do, too.
What the New Research Actually Says
Let’s talk facts (with transparent receipts):
- In an 18-year follow-up of the original WHI study, there was no difference in death rates between women who took HRT and those who didn’t (this was with all-cause mortality [aka death in general] as well as cause-specific mortality [i.e., death from cardiovascular disease, cancer, and other significant causes]) (3).
- Women who started HRT before age 60, and within 10 years of menopause, had a 39% lower risk of death than those who didn’t take hormones (3). That’s not small potatoes.
- The risk of breast cancer appears to be more closely linked to synthetic progestins - not bioidentical progesterone - and oral estrogen, not transdermal (skin patch or cream) forms (3,4).
So no, HRT isn’t the villain it’s been made out to be. It's just been misunderstood, kind of like bangs during a midlife crisis (not that I'd know anything about that, lol).
What About Brain Health?
Estrogen doesn’t just keep bones strong and hot flashes in check - it’s also a key player in brain health.
Women lose up to 20% of their brain’s metabolic activity during the menopause transition. That’s a big deal. It’s also one reason why women are at higher risk of developing Alzheimer’s than men (6).
But here’s the hopeful part: estrogen replacement (when used early in menopause) might actually help prevent this brain fog/cognitive decline trajectory. It’s not a miracle cure, but it’s certainly something to consider before tossing another supplement into your Amazon cart.
Bioidentical Hormones: What’s the Hype?
You’ve probably heard the term “bioidentical hormones” floating around recently, and no, it’s not just a buzzword.
Bioidentical = hormones that are structurally identical to the ones your body makes. And they’re often better tolerated than synthetic versions. Plus, when applied via the skin (transdermal), estrogen bypasses the liver, reducing the risk of blood clots and strokes.
Micronized progesterone (the gentler, bioidentical cousin of synthetic progestin) has also not been associated with the same breast cancer risk seen in older studies.
One More Thing - POI
Premature ovarian insufficiency (POI), aka menopause before age 40, is a different beast. Many women in this category are handed birth control pills to “manage” things. But synthetic hormones do not equal physiological replacement. These women need actual HRT to protect their bones, hearts, and brains long-term. If you’re under 40 and on the pill for POI, I highly encourage you to revisit your options. You deserve better.
So, Is HRT for You?
Maybe. Maybe not. Like your favorite pair of jeans, HRT is not one-size-fits-all. Factors like your personal and family history (especially breast or hormone-sensitive cancers) must be weighed carefully. But the important thing is this: you deserve full, honest, up-to-date information - not blanket statements rooted in 20-year-old data.
That’s why a personalized, functional medicine approach matters most - one that weighs your unique health history, family risk factors, and symptoms to make the best choice for you.
Let’s Take the Confusion Out of Hormones
If you’re tired of being told “you’re fine” when you feel anything but, I’m here to help.
Let’s talk about your symptoms.
Let’s look at your labs.
Let’s make a plan that supports your whole health - from hot flashes to heart health.
If you suspect you may be showing signs of perimenopause, if you’re in the midst of menopause symptoms, or if you wish to discuss the use of BHRT, schedule your initial consult with Functional Reset NP today. Let’s start restoring balance to your hormones, your brain, and your life.
References:
- Manson JE et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 2013 Oct 2;310(13):1353-68.
- Manson JE, Kaunitz AM. Menopause Management--Getting Clinical Care Back on Track. N Engl J Med. 2016 Mar 3;374(9):803-6.
- Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials. JAMA. 2017;318(10):927–938.
- Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353-1368.
- https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/hormones-and-dementia#:~:text=Oestrogen's%20protective%20effects,of%20the%20amyloid%2D%CE%B2%20protein.
- Scheyer O, Rahman A, Hristov H, Berkowitz C, Isaacson RS, Diaz Brinton R, Mosconi L. Female Sex and Alzheimer's Risk: The Menopause Connection. J Prev Alzheimers Dis. 2018;5(4):225-230. doi: 10.14283/jpad.2018.34.
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