Hormone replacement therapy (HRT), also known as meno-pausal hormone therapy, a treatment designed to combat the discomforts of menopause, is officially a hot topic. It’s been championed on The Oprah Winfrey Show, discussed on the TV shows Today and Larry King Live, advocated by actress Suzanne Somers and has attracted controversy from media outlets to doctors’ offices.
The therapy is used to ease menopause, which can last a few months to a few years. As women age, the hormone estrogen—which features in the reproductive system and contributes to healthy bones, heart and blood vessels—decreases in production. Less estrogen in a woman’s system raises her odds for developing heart disease, osteoporosis and vaginal dryness.
The treatment works like this: estrogen, often in combination with progestin, a synthetic version of progesterone, is taken in the form of a pill or patch to relieve menopause symptoms like hot flashes. For many women, there seem to be added benefits: increased HDL (“good cholesterol”) and decreased LDL (“bad cholesterol”) as well as reduced risk of colon cancer, prevention of bone loss and reduced risk of osteoporosis-related bone fractures.
Judging the Risk
The therapy may sound like a panacea, but changing a body’s natural chemistry has its risks, including slightly increased risk for breast cancer, endometrial cancer (when only estrogen is taken), slightly increased risk for gallstones, increased risk for development of blood clots (which can lead to a stroke) and more. Side effects reported by some women include breast tenderness, spotting or a return of monthly periods, cramping and bloating.
When considering HRT, some women are more at risk than others: red flags include past blood clots in legs or lungs, breast cancer or high blood pressure. Doctors recommend that women who have had a history of uterine or ovarian cancer, heart disease, liver or gallbladder disease avoid the therapy. But for women with a history of good health, the risks are smaller, says Dr. Margery Gass, executive director of the North American Menopause Society. Risks and benefits are likely the same for all HRT delivery systems: pills, patches, vaginal creams, gels, rings or other forms.
So, how does a woman decide whether or not to seek relief through hormones? First, “she should decide if symptoms are bothersome enough to take anything,” says Dr. Gass. If a woman decides to take the treatment, doctors advise using the lowest effective dose possible for the shortest amount of time needed to treat debilitating menopausal symptoms.
Though the Mayo Clinic considers estrogen the gold standard for treating menopause symptoms, alternative therapies may offer some relief, too. Natural hormones, such as estriol, can be used to treat hot flashes if taken in high doses, according to the National Research Center for Women & Families. Natural progesterone, too, may help to cool hot flashes, though there’s no evidence yet that progesterone aids bone density.
Vitamin C with bioflavonoids (plant compounds from citrus, green tea, cocoa and other sources high in antioxidants) have been used to help strengthen capillaries and to alleviate hot flashes. Phytoestrogens, or plant-derived estrogens found in foods such as soy and red clover, may also help relieve some symptoms of menopause. But researchers disagree about whether phytoestrogens actually work, according to the National Center for Complementary and Alternative Medicine, and doctors warn women with an increased risk for breast, uterine or ovarian cancer, endometriosis or uterine fibroids to avoid these plant estrogens.
If the symptoms are mild, or if hormone therapy is a risk, women can look at more natural options. “Certainly she can look at modifying her lifestyle to minimize hot flashes, and avoid situations where her internal temperature goes up,” says Dr. Gass. Such self-monitoring includes recognizing hot-flash triggers—such as wearing synthetic fabrics or eating processed foods—and avoiding them. For milder symptoms, women may be able to find relief through exercise, yoga, meditation, deep breathing and avoiding alcohol and caffeine.
Where Hormones Go
About 100 pharmaceuticals—including estrogens from HRTs—have been found in our waterways. Because of the chemical properties of drugs, such hormones cannot be filtered from our drinking water in the water purification process, and concentrations can be particularly high around treatment plants’ effluent pipes.
The implication of hormones in our waterways isn’t entirely known, according to Jerry Heindel, PhD, scientific program administrator at the National Institute of Environmental Health Sciences. “What we do know is there have been some instances where scientists have noticed that estrogenic hormones in water have affected some fish and other aquatic animals,” he says. Estrogen can feminize male fish, causing them to grow ovaries; the result is bungled reproduction capabilities.
As for us, “It’s unlikely that it’s affecting humans because the doses are too low,” says Heindel. However, he says, “It’s not good to have hormones in the water at any concentration.”