Hormone replacement or not? That is a question for many menopausal women. (For Spectrum Health Beat)
Hormone replacement or not? That is a question for many menopausal women. (For Spectrum Health Beat)

Face it: Women as a rule worry more than men. And one thing they worry about as they age is hormone replacement.

Women who reach menopause—typically between ages 48 to 60—or who experience surgical menopause after a hysterectomy are faced with deciding whether or not to take estrogen to replace the hormones formerly produced by their ovaries.

It’s not an easy decision, particularly since women have been hearing for years about the link between hormone replacement therapy and cancer.

A Spectrum Health OB/GYN and nationally recognized menopause expert says women should “look at the data” before jumping to conclusions about the risks involved in taking estrogen.

“Women need to know the facts when they speak with their providers about hormone therapy,” said Diana Bitner, MD, Spectrum Health Medical Group. “And the facts have changed and our knowledge has grown because of several large scientific studies.”

Dr. Bitner says the alarm about cancer and hormones was raised in the past few decades by several studies, including the Women’s Health Initiative released in 2002.

Since then, further research has led to understanding the “timing hypothesis”—a window of opportunity that helps determine which women should or should not start taking hormones. Also, the hormones themselves have changed. The estrogen that women are taking today is “bio-identical” to what it produced naturally by the ovaries and it is FDA approved.

“The women at most risk of developing breast cancer related to hormone therapy are post-menopausal with an intact uterus and who take oral synthetic progesterone—but it’s still very low,” Dr. Bitner said.

She strongly recommends hormone replacement therapy for women who are less than 10 years from their last menstrual cycle and who do not have metabolic syndrome. If they have a uterus, they should consider using micronized progesterone, which is closest to the progesterone formerly produced by the ovaries.

“Women with metabolic syndrome, obesity, or diabetes are at more risk for cardiovascular events and this needs to be considered when deciding whether to choose hormone replacement therapy,” Dr. Bitner added. “At the right time in the disease process, hormones can help while later, as the disease progresses, they can hurt.”

The benefits of taking estrogen: preventing bone loss, reducing risk of stroke and heart disease, and reducing menopause symptoms, allowing for better sleep and quality of life.

“It is important to see a provider who is aware of the science-based risks and benefits and can help you make an informed decision,” Dr. Bitner said. “Many of my patients on hormone replacement therapy tell me that they feel like themselves again.”

Women considering hormone therapy should ask their doctors:

  1. What stage am I in?
    “Women need to know if they are in perimenopause or menopause,” Dr. Bitner said. “Age is not an indicator and physicians need to examine the stage of ovarian function and symptoms.”
  2. Am I a candidate for hormone replacement therapy? If not, why?
    “You want your physician to look at your risk factors and fully inform you when making this decision.”
  3. What is your comfort level recommending hormone therapy?
    “Not every primary care provider is an expert in hormones,” she said. “They may or may not be familiar with the most recent research. You may need to speak with someone who specializes in menopause and who has good data.” Dr. Bitner highly recommends seeking out a practitioner certified as an menopause expert by the North American Menopause Society.