Another Look at Hormone Replacement during Menopause

Many women feel conflicted about the decision whether to use hormone replacement therapy (HRT) to ease uncomfortable symptoms associated with menopause. Trends in the use of hormone replacement have shown a steep decline since the release of the Women’s Health Initiative (WHI) study that raised concerns about increased risks of breast cancer and heart disease.

Since that study was published over a decade ago, researchers have re-examined several of its conclusions, and new research continues to expand our understanding of the issue.

There has never been general agreement among women’s health experts and those caring for women in the community about whether the strong cautions against hormone replacement that came out of the WHI were an overreaction. A number of leading academic physicians, scientists, women’s health organizations and advocacy groups have criticized some of the recommendations that grew out of the WHI.

A recent documentary film Hot Flash Havoc summarizes several of these criticisms. The film which compiles interviews with both women’s health experts and individual women, takes a skeptical look at the WHI. Its title refers to the havoc that the WHI created for women experiencing a difficult menopause.  It has circulated through theatres and women’s events, and has been available to the public through WalMart. A few weeks ago its producers made it available via Internet streaming from its website The 5-day rental cost is $9.95.

Other women’s health organizations have also spoken out recently with more positive views of the benefits of HRTs.  An international meeting of global organizations working on menopause and women’s health released a statement in March calling HRTs “the most effective treatment for symptoms of the menopause, and that benefits are likely to outweigh any risks for women going through the menopause. However it advises women to only take [HRTs} after discussing her individual health circumstances with her doctor.” The entire Global Consensus Statement on Menopausal Hormone Therapy is available at .

So the controversy continues and women remain uncertain about whether estrogen (or estrogen with progesterone if they have not had a hysterectomy) will benefit them or harm them. I advise my patients that the decision whether to use hormone replacement therapy is a very personal one. I encourage them to think carefully about their individual menopause experience. How bothersome are hot flashes, sleep disturbances, mood changes, or other common menopausal symptoms? How much do these bothersome symptoms impact daily life? What individual and family risk factors might influence the decision? I explain to patients that menopausal symptoms occur in a continuum. On one extreme are women who have absolutely no symptoms, and on the other—women who have such poor quality of life due to menopausal symptoms that they view hormone replacement as a necessity. I individualize my recommendations according to where a woman feels she fits into that spectrum, along with her risk factors.

There is no one-size-fits-all recommendation for enjoying menopausal years with a feeling of well-being. My wife once commented, “Maybe it’s unnatural for women to avoid the symptoms of menopause. We are all biologically programmed to be menopausal at some point.” An interesting question, to which I replied (after a thoughtful minute) “Women are not programmed to outlive their ovaries.” As recently as the turn of the 20th century, average life expectancy for American women was 48.3 years. On average women spent none or very few years in menopause. The average woman born today will live beyond 80. Millennium women can expect to spend a third or more of their lives in menopause!

With this in mind, one conclusion is certain. Your decision, and your physician’s advice in helping you reach that decision, should focus on achieving the best possible health and quality of life for the many years you will enjoy after you enter menopause.