If you’ve heard of hormone replacement therapy (HRT) as a treatment for menopause, and you have been confused by what you’ve heard, you are not alone!

Take it from Dr. JoAnn Manson, the lead investigator of the largest study on HRT in postmenopausal women (The Women’s Health Initiative), who says: “The pendulum has swung so widely, from ‘hormone therapy is good for all women’ to ‘it's bad for all women’ to now somewhere in between.”

So what are the current recommendations, and what should you know? We’ll break it down for you here.

A Brief History:

The Women’s Health Initiative was a study of 27,347 postmenopausal women, ages 50–79 years, at 40 U.S. centers, and one of the main goals was to understand if HRT was beneficial for postmenopausal women.

In 2002, the first findings of this study showed that women who were on HRT long term had an increase in bad health outcomes like heart disease and stroke. At this point, almost 40% of women were using HRT to prevent chronic diseases – but after these results were shared, women in general stopped using HRT altogether.

In 2013, the final results from this large study were published and had some important clarifications to the previous findings. These new results were broken down by age and time since menopause, and showed that HRT should not be used for long-term chronic disease prevention, but can be helpful for women in early menopause for menopausal symptoms!

Dr. Manson says that the intention was never to deny HRT to women in early menopause, but the results from these studies were often misinterpreted by both women and their clinicians.

What we know now:

Women need individualized care when thinking about using HRT for menopausal symptoms. It is very important to break down recommendations by age and time since menopause.

• The North American Menopause Society considers hormone replacement therapy (HRT) t0 be safe and effective for most women - especially when started prior to age 60 or within 10 years of menopause.

• Do not use hormones for chronic disease prevention due to the increased risk of blood clots and stroke with long-term use.

• Do consider HRT in younger women (before turning 60) for the treatment of moderate to severe symptoms of menopause for short-term use. Vasomotor symptoms that can be treated with HRT are hot flashes and night sweats.

• Women in early menopause are likely to have quality of life benefits that outweigh the small likelihood of adverse events in younger women.

Summary:

Our understanding of when HRT is appropriate to use has changed pretty drastically over time. HRT should not be used for all postmenopausal women, but it can be helpful for some.

Questions to think about and discuss with your clinician:

• Where in the menopause transition are you?

• Do you have contraindications to HRT? Some examples include history of cancer, blood clots, stroke, and heart disease.

• Are you having bothersome menopausal symptoms? Vasomotor symptoms like hot flashes and night sweats can lead to impaired health and quality of life, disrupted sleep, reduced work productivity, and increased health care expenditures.

Stay tuned for a questionnaire you can take from Mina Health which will help guide your individual options and if menopause treatment might be right for you.

Estrogen Matters provides an in-depth history on HRT.

Milli Desai, MAS, MHS received her Master’s in Clinical Research from UC San Diego as a National Institutes of Health TL1 pre-doctoral scholar, and received her Master’s in Health Sciences from the Johns Hopkins Bloomberg School of Public Health