When Is HRT Actually Indicated?
PHEW! There is some serious controversy around this especially as there are the guidelines and then there are clinical experiences or new research articles not yet included in the guidelines.
When it comes to estrogen in particular, I want to outline what is recommended. Do keep in mind that a guideline is not a law - this piece of advice was given to me by an oncologist (believe it or not). However, it’s a solid place to start if you’re considering hormones.
Right now, the Menopause Society (formerly North American Menopause Society) reviews the research and has stated: hormone therapy remains the first-line therapy for the management of your hot flashes/night sweats (vasomotor symptoms) as long as the benefits outweigh the risks if you’re under 60 years old and starting these hormones within 10 years of going through menopause.
They also say hormone therapy is indicated for:
Genitourinary Syndrome of Menopause (all things related to your vagina and bladder)
Primary ovarian insufficiency
The prevention of bone loss or to reduce your risk of bone fracture
Here’s where it gets interesting. While hormone therapy may help your other symptoms like brain fog or insomnia, the guidelines specifically state estrogen-containing hormone therapy is NOT recommended for:
The primary prevention of cardiovascular (heart) disease
The primary prevention of dementia
The management of your musculoskeletal issues like frozen shoulder or joint pain (although see my video about the NEW research on the Musculoskeletal Syndrome of Menopause)
The management of other age-related changes like your hair, skin and nail changes or for weight loss
Based on my observations of the research field, I would imagine this will change and be updated with time. For example, the brain research by Dr. Lisa Mosconi, Dr. Dale Bredesen, Dr. Kellyann Niotis (and more) have me very excited for the future of women’s brains in this menopausal transition.
Anecdotally from patients, social media comments and messages, I have also heard MANY women report their hormone therapy helped their brain, muscle, hair, skin, and joint symptoms for the better if dosed appropriately!
However, the guidelines are worded as hormones should not be considered the “primary” prevention. I would push on this to say hormones can absolutely be considered as part of a holistic, integrative plan for you (if you’re a hormone candidate and want to use them).