Should Women In Their Fifties Undergo Hormone Replacement Therapy? It's Clear As Mud

Over the next 10 years, there will be 25 million women in the US turning 50. One tough question at that point is whether or not to start hormone replacement therapy or not. It's really not an easy answer, and one that has changed over time with new findings.

Estrogen was initially thought to be great for helping with menopause, bone strength, anti-aging, and libido. But ten years ago, estrogen was shown to raise the incidence of breast cancer and heart disease. So the tide turned against it understandably.

Now things are clear as mud. In the study that showed the increase risk of adverse effects with estrogen (including cancer), there was actually a decreased risk of breast cancer among women who took estrogen alone, without progesterone. Why? Some think it was due to the particular kind of progesterone used in those patients that caused the increased risk of cancer. Some newer studies have suggested using natural progesterone along with estrogen in either smaller doses or for less days in the month.

The tide is turning back in favor of women going on hormone replacement during menopause and after. With minimal exposure to progesterone of a natural form, breast cancer may be minimized, and the benefits of the hormones are substantial. Reduced hip fracture risk, and better bone and cardiovascular health ensue. Also, mood swings may be reduced, diabetes risk is lowered as well. Estrogen may lower one's risk of colon cancer too.

Hot flashes are minimized, vaginal hydration is helped, and certain types of cancer are even reduced. There is some research showing that fluctuating hormone levels during menopause can cause depression, memory problems, and depressed cognition. Considering that if a woman sustains a hip fracture there is over a 25% chance of death within a year, hormone replacement has its place assuming the cancer risks are mitigated. Additional side effects of estrogen include a slightly increased risk of stroke, pulmonary embolism, and dementia after age 65.

There are critics of HRT who say that there are plenty of medicines that can address the symptoms. But they are not symptom free. Consider bisphosphonates, which can assist with bone health but have been linked recently to femur fractures and muscle pain.

Recently, there has been an increased interest in bioidentical hormones, which are the same hormones as in traditional HRT, but represent the natural hormone rather than being manufactured synthetically in a lab. The benefits can be tremendous without the side effects of some of the synthetic versions.