Is Hormone Therapy Worth the Risks?

Hormone replacement therapy (HRT) is remarkably effective at silencing the frequent hot flashes, sleep disturbances and painful sex that can come with menopause. But, the highly publicized link between HRT and an increased risk of heart disease, blood clots and stroke still has many women worried.

Researchers once believed HRT (using a combination of estrogen and progesterone) reduced the risk of heart disease, while also preserving bone health. Then, a study by the Women’s Health Initiative (WHI) in 2002 uncovered an increased risk of cardiovascular disease among a subset of women using HRT. The controversy continues, with more recent studies suggesting HRT isn’t as risky as many perceive it to be. In fact, some studies say taking HRT for a short period at the beginning of menopause may have beneficial effects, including a lower risk of certain forms of cancer and heart disease.

The risks and benefits of HRT are admittedly confusing. So, women whose menopause symptoms are intense enough to dramatically impact their quality of life should consult their doctors about all their options. A growing number of women are seeking relief through bioidentical hormones, herbal supplements and even simple lifestyle strategies—each with variable levels of effectiveness.

Below are some of the most popular therapies.

Traditional HRT

Usually a combination of estrogen and progesterone, HRT “replaces” the hormones your body no longer makes due to menopause. Studies show HRT not only effectively diminishes menopausal symptoms, it may also protect your bones. Nevertheless, it comes with risks, and age makes a big difference. Women in their 60s may be at increased risk for heart disease. It’s best to take the lowest dose needed, for the shortest amount of time.

Bioidentical hormones

Bioidentical hormones are manufactured in a laboratory from compounds found in plants (mainly soybeans and wild yams). Supporters claim the plant-based hormone’s structure is identical to the estrogen, progesterone and androgens the body makes naturally, but research has not confirmed this. The U.S. Food and Drug Administration (FDA) has approved several bioidentical hormones, including the topical drug Estrace. But, because compounded bioidentical hormones don’t undergo the same scientific scrutiny as their FDA-approved counterparts, they could carry the same cancer and heart disease risks as traditional HRT.

Herbal supplements

Unlike prescription or over-the-counter medications, dietary supplements do not need to be approved by the FDA. Data on these products has only been collected for 10 to 15 years, compared to more than 60 years for traditional HRT. While some studies suggest supplements including soy isoflavones, evening primrose oil, dong quai and black cohosh help curb symptoms of menopause, their level of effectiveness has yet to be proven.


Practitioners of Chinese medicine believe inserting needles into specific pressure points affects the life energy flowing through the body. Although several studies support acupuncture’s ability to relieve menopausal symptoms—especially hot flashes—it is not scientifically clear how or why this works. Since the benefits of acupuncture likely outweigh the risks, it might be worth trying.

Topical Solutions

A topical treatment may be sufficient for relieving pain with sexual intercourse or a burning sensation during urination. It’s important to tell your doctor about your particular symptoms, so he or she can tailor treatments for maximum relief. You may be able to avoid most of the risks associated with more systemic, oral treatments.

Lifestyle Strategies

Whether you choose to treat or tolerate menopausal symptoms, be sure to:

  • Eat well
  • Exercise regularly
  • Get sufficient sleep
  • Wear layers, so you can shed them as things heat up
  • Have a fan and a clean nightshirt near your bed, in case you wake up in a sweat
  • Try mindfulness practices, including deep breathing, meditation and guided imagery

Whichever menopause symptoms you are experiencing, remember they are only temporary—as are the treatments you choose. After a few months, or even a couple of years, many women find they can gradually decrease treatments without compromising their quality of life.


Have you experienced intense symptoms of menopause? What did you find most helpful? Let us know in the comments below.

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