If you are considering hormone replacement therapy for the management of your menopausal symptoms, it’s important to know the benefits and risks. Naturopathic doctors commonly prescribe hormone replacement therapy for perimenopausal and menopausal concerns. Along with reviewing a person’s individual risk factors, an informed decision making process is always a part of the hormone consultation. I base my informed decision making conversation around the North American Menopause Society's (NAMS) guidelines, which I will review here.

Benefits of Hormone Replacement Therapy:

1. Relieves Hot Flashes and Night Sweats: Hormone replacement therapy can help relieve hot flashes and night sweats, which are common symptoms of menopause.

2. Improves Sleep: Hormone replacement therapy can help improve sleep quality and fatigue if night sweats and hot flashes are waking you in the night.

3. Improves Vaginal Dryness: Hormone replacement therapy can help improve vaginal dryness, which is another common symptom of menopause.

4. Reduces Risk of Osteoporosis: Hormone replacement therapy can help reduce the risk of osteoporosis, which is a condition that weakens bones.

5. Improves Mood: Hormone replacement therapy can help improve mood and reduce the risk of depression.

6. Improves Heart Health: Hormone replacement therapy might be good for your heart if you start before age 60 or within 10 years of menopause.

Potential Risks of Hormone Replacement Therapy:

The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used.

For women with no contraindications aged younger than 60 years or within 10 years of menopause, the benefits of hormone therapy generally outweigh the risks for management of hot flashes and night sweats and prevention of bone loss. Hormone therapy might slightly increase your risk of stroke or blood clots in the legs or lungs (especially if taken in pill form). If started in women aged older than 65 years, hormone therapy might increase the risk of dementia. Hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than 4 to 5 years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at 7 years but may increase risk if used for a longer time. If you start hormone therapy further from menopause or after age 60, HT might slightly increase your risk of heart disease.

Although there are risks associated with taking hormone therapy, they are not common, and most go away after you stop treatment. In general, hormone therapy is associated with approximately 1 additional harmful event per 1,000 women per year. For example, the increased chance of breast cancer with hormone therapy use is just under 1 extra case per 1,000 women per year.

Do These Risks Apply to Bioidentical Hormone Therapy?

Bioidentical hormones are a type of hormone replacement therapy that use prescription hormones that are identical to what your body produces. There are many Health Canada approved bioidentical hormone preparations. The risks of bioidentical hormones are similar to non identical hormone preparations, however NAMs does recognize there may be some caveats to this rule, and further research in this area is needed. For instance, micronized progesterone, which is a Health Canada approved bioidentical progesterone, may be less thrombogenic, and may have lesser of an association with breast cancer than other progestins. 

If you are interested in hormone therapy, please don’t hesitate to contact Juniper Family Health to book an initial naturopathic consultation. We are here to help!

In health and happiness,

Dr. Meghan van Drimmelen | Naturopath Victoria BC

References:

NAMs Position Statement: The 2022 hormone therapy position statement of The North American Menopause Society