Menopause and its little sister, perimenopause, are having a moment. It may be a moment when you’re dripping with sweat and unsure of your own name, but it’s still a moment.
And it means that more and more women are talking about the big change and destigmatizing it – and we think that’s great. But sometimes more chatter means more misinformation. That’s why we’re here to debunk six common myths about estrogen’s role in hormone therapy (HT), the most effective treatment for menopause.
1. Hormone therapy causes weight gain.
Hormone therapy does not result in significant weight gain, said Barbra Hanna, DO, FACOG, MSCP, in Wheaton, IL.
While many women notice weight gain and body changes as they age, Hanna explained that weight gain in midlife is more likely to be due to age-related metabolic changes rather than hormone therapy itself.
And on the other hand, Barb DePree, MD, FACOG, NCMP, MMM, director of women’s health at Holland Hospital and a member of HealthyWomen’s Women’s Health Advisory Council (WHAC), pointed out that hormone therapy could help someone struggling with hormone-related symptoms that impact their lifestyle, although there are no studies yet that clearly establish a connection between estrogen and weight in any way, up or down.
“Hormone therapy can be helpful for weight maintenance because when you sleep better, your mood is better. You have less joint pain…at all.” [which] could help you make better lifestyle choices and the result could be improved weight control.”
2. Estrogen increases a woman’s risk of cancer.
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The myth that estrogen increases the risk of cancer is one of the most well-known and enduring – but also wrong. This myth dates back to the 2002 Women’s Health Initiative study, which aimed to examine the risks and benefits of hormone therapy in postmenopausal women.
While this study found a slightly increased risk of breast cancer in women, DePree says there are two important facts women need to know about these findings:
- The increased risk was only seen with a specific type of estrogen given along with a synthetic version of progestin.
- Women who were given estrogen alone in the study were actually less likely to develop breast cancer than those who were given the placebo.
Despite these important facts stating that estrogen does not cause breast cancer, the study caused much excitement and continued fear. Fortunately, these insights have been replaced by better data.
Today, DePree explained, “doctors do not view hormone therapy as a significant breast cancer risk.”
However, what can increase your risk of breast cancer are factors such as breast density, family history, genetic mutations, alcohol consumption, lack of exercise, diet and smoking.
Read: More research shows vaginal estrogen is safe for people with a history of breast cancer >>
3. Estrogen increases the risk of heart attack and stroke.
Estrogen can increase the risk of a heart attack or stroke, but there’s a catch, DePree said: The risk depends entirely on how the dose is administered. Oral estrogen, such as that found in birth control pills, may increase the risk, but the patch, which is administered transdermally (through the skin) or vaginally, does not.
She explained that oral estrogen is processed by the liver, causing a blood clotting protein to change slightly enough to increase the risk of blood clots. However, almost all HT is administered in the form of a patch or in forms other than pills, meaning there is no risk of oral estrogen delivery.
Of course, anyone suffering from cardiovascular disease or at risk of stroke should always discuss their risk with their healthcare provider (HCP).
4. You should wait to take hormone therapy until your symptoms are really bad.
iStock.com/David Petrus Ibars
That statement is definitely false, says Mary Jane Minkin, MD, co-director of the Sexuality, Intimacy, and Menopause Program for Cancer Survivors at Smilow Cancer Hospital at Yale Medical Center and a member of HealthyWomen’s WHAC.
“I tell women that if they have symptoms, we can start hormone therapy,” she said.
Hanna placed even more emphasis on when to start HT: “Let me be clear,” she said. “Women who still have their period but are experiencing symptoms can safely begin hormone therapy. No one should suffer symptoms until they have gone a year without a period. The hormonal chaos of perimenopause is real and women deserve treatment options.”
Not only can hormone therapy relieve symptoms for some women, but DePree added that research has shown that the closer HT is started to the onset of menopause, the lower the risks associated with its use.
5. Natural remedies are safer than hormone therapy.
Hanna is also keen to debunk this myth, particularly when it comes to doctors selling compounded “natural” hormones to women that are not covered by insurance and have high prices.
“Compound hormones are not FDA-approved, lack standardization, and may pose unknown risks,” she explained. “There are FDA-approved bioidentical HT options that are safer than compounded, unregulated versions.”
Additionally, FDA-approved HT is covered by health insurance.
6. You can only do hormone therapy for a few years.
“The use of [HT] “There is no age-based expiration date,” Hanna said.
The Menopause Society’s official position is that women can safely use HT until age 65 and then have an individual risk-benefit discussion with their HCPs about stopping or continuing.
The bottom line, according to DePree, is that female hormones are nothing to fear, especially considering that most women never question them when their bodies produce them naturally. “For about 40 years, our ovaries produced hormones very efficiently, and no one ever questioned the safety or usefulness of exposure to female hormones,” she said.
“So is there something about when you turn 52, 55 or 45 that hormones are no longer advisable and shouldn’t be considered? I think the answer is no.”
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