Unwinding the Knot: A Brief History of The Safety of Female Hormone Replacement Therapy and its Cardiovascular Benefits

As women go through life, they experience many changes both mentally and physically. One of the biggest physical changes of a woman's life is menopause. This period of time begins 12 months after a woman’s last period (menstrual cycle), which is typically between the ages of 45 and 55 years old.¹

During menopause, the hormones progesterone and estrogen drop, and this causes symptoms like hot flashes and mood changes. The severity of these symptoms range from woman to woman, but they can sometimes be severe enough to require treatment.

In the 1960’s a treatment for menopausal symptoms called hormone replacement therapy (HRT) was developed. This effective treatment was used by many women to improve their menopausal symptoms, quality of life, and also decrease the risk of many diseases.

Unfortunately, a large study that was conducted during the 1990’s falsely concluded that HRT was harmful to patients. And even though this conclusion was retracted, there continues to be large amounts of misinformation surrounding HRT. This has resulted in a great resistance from physicians to prescribe HRT for their patients. 

But the research doesn’t lie. Over the last 25 years, HRT has been proven time and time again to be safe and beneficial for menopausal women. For this reason, I prescribe HRT for many of my patients, and many have had improvements not only in their health but their overall quality of life. 

What is Hormone Replacement Therapy?

Hormone replacement therapy is an FDA-approved treatment, and it involves the replacement of the hormones that drop during menopause. The most common type of HRT involves replacing estrogen, which is responsible for reproduction and the development of female characteristics. It’s also called estrone, estradiol, and estriol.²

The drop in estrogen that occurs in menopause is what causes the uncomfortable and unwanted symptoms of menopause. Some of these symptoms include:¹

  • Hot flashes

  • Weight gain

  • Mood changes

  • Difficulty sleeping

By replacing the estrogen that is lost, HRT works extremely well to alleviate these symptoms.³

The first hormones used in HRT were Premarin and Provera, which are synthetic hormones. This means that they were made in a laboratory with man-made chemicals. The downside to synthetic hormones is that they do not have the same structure as the hormones your body makes. And while the body can often convert them into usable forms, many people have difficulty breaking them down to detoxify them. 

For this reason, I use bioidentical hormones. These types of hormones are made from natural, plant sources. Some examples of bioidentical hormones are estradiol, estriol, and progesterone. They have the same structure as the hormones your body makes. I’ve found that patients respond much better to these types of hormones for HRT. 

In America, the use of bioidentical hormones hasn’t been well studied and likely never will be. This is because these types of hormones cannot be patented, and this has resulted in no funding to support research. 

However, I’ve found that bioidentical hormones have been well studied in countries outside of America and have been found to be safer and more effective than synthetic hormones.⁴ For this reason, bioidentical hormones are largely used over synthetic hormones in the countries that have studied them, such as in European Nations. 

Hormone Replacement Therapy and the Women’s Health Initiative Study

In the late 1990s, a large randomized study called the Women’s Health Initiative was started and falsely concluded that HRT causes an increased risk of heart disease and breast cancer.³ This caused panic among doctors prescribing HRT, and doctors were obligated to immediately stop prescribing HRT to their patients. 

However, the results of this study were eventually determined to be incorrect, as they failed to consider the ages of patients in the trial. When all of the data were sorted out, we were able to figure out that the benefits of HRT come down to when it’s started. This discovery is now referred to as “the timing hypothesis.”⁵

This basically told us that when it comes to starting HRT, the most important thing is when it’s started. The sooner HRT is started, the more beneficial it is. 

HRT is safe and does not increase the risk of breast cancer and heart disease when started before the age of 60 years old or within 10 years of the start of menopause. But there may be some increased risk to patients when HRT is started after the age of 60 years old or more than 10 years after the start of menopause. However, it’s important to note that there is no increased risk of harm when HRT is continued after menopause.⁶

Not only has this been proven by re-evaluation of data from the Women’s Health Initiative, but the safety and effectiveness of HRT has been proven in larger studies like the Nurses’ Health Study.⁷

But this unfortunately has not been widely publicized, and the misinformation surrounding HRT has continued. This has resulted in physicians continuing to deny their patients the option of taking HRT in menopause - even though HRT has so many benefits. 

Many that could even be life-saving.

What Are The Benefits of Hormone Replacement Therapy? 

Over the years, many benefits of HRT have been proven. The benefits of HRT are a result of the replacement of hormones that are lost as a result of menopause.

The replacement of estrogen helps reduce the unwanted symptoms of menopause, but it also comes with many other benefits. Estrogen replacement has been proven to prevent certain diseases like:³

  • Heart disease

  • Alzheimer’s Disease

  • Osteopenia and Osteoporosis  

  • Colon Cancer⁸

During menopause, the drop in estrogen can also cause many unwanted changes in the bladder and vagina. When applied vaginally, estrogen replacement therapy works to prevent thinning of the vaginal wall, which is also called vaginal atrophy, and decrease urinary incontinence and urinary tract infections.⁹

Estrogen replacement therapy benefits the eyes in many ways too. It’s been shown to prevent vision loss caused by macular degeneration¹⁰ and also prevent cataracts.¹¹

Lastly, estrogen replacement works to keep body fat from getting stored around our organs, which is called visceral fat. This is important to prevent as this type of fat storage can cause an increased risk of many diseases like diabetes, fatty liver disease, and heart disease.¹²

One of the biggest benefits of HRT, and the one I’d like to talk a bit more about, is the prevention of cardiovascular disease.

How Does Hormone Replacement Therapy Reduce the Risk of Heart Disease? 

When women go through menopause, many changes take place within their bodies. One of the major changes that occurs is within the cardiovascular system, which is made up of the heart and blood vessels in the body.

Estrogen has been found to protect the cardiovascular system and prevent diseases like high blood pressure and high cholesterol. So when estrogen levels drop in menopause, these protective benefits drop too.⁵

As mentioned before, the Women’s Health Initiative falsely concluded that HRT increased the risk of heart disease. We now know that this false conclusion was due to the majority of women in the trial being over 10 years out of menopause and over the age of 60 years old. 

A second large study done on HRT, The Nurses’ Health Study, took a look at a much larger group of women that had an average age less than 60 years old. Results of this study found that HRT with estradiol causes a decreased risk of cardiac events such as heart attacks. 

Estradiol is protective to the heart and blood vessels because it’s been shown to prevent and decrease many of the risk factors for heart disease. Estradiol has been shown to: 

  • Improve cholesterol levels¹³

  • Help maintain a healthy weight¹²

  • Reduce the risk of diabetes

  • Slow and prevent plaque build up in blood vessels⁷

The Nurses’ Health Study proved that when started around the time of menopause, the benefits of HRT far exceed any potential risks.

Are You Going Through Menopause?

As you now know, HRT has been and continues to be a widely debated topic in medicine. And unfortunately due to the false conclusions made by the Women’s Health Initiative, women continue to be denied HRT for treatment of their menopausal symptoms and prevention of many diseases.  

As with anything in medicine, it’s always important to weigh the risks and benefits of treatments. And for HRT, the research continues to show that the benefits of HRT far outweigh the risks. This is why I recommend it to many of my patients who are going through or approaching menopause.

If you’re going through menopause and want to know more about how you can improve your quality of life while preventing diseases like heart disease, Alzheimer’s disease, and osteoporosis, please talk to your primary care provider about how this might be a good option for your preventative healthcare plan. 

And if your primary care provider doesn’t understand the benefits of HRT for menopausal women, then please visit a functional medicine doctor or naturopathic medical provider in your area. They may be more likely to understand the benefits of HRT, be able to make recommendations, and prescribe HRT for you.