HRT After Menopause: What Are the Risks and Benefits?

Transcript:

Jamie Forward: We’ve received this question from one of our viewers. So, what are your thoughts on HRT for women 10 years post-menopause who are having symptoms and signs, osteoporosis, for example? Dr. Ali?

Dr. Nina Ali: That’s a great question. And it’s a clinical question that comes up not infrequently in our practice. And again, I think we have to look at what the goals are and look at that person and see what medical issues they’re coming in with. Most of us, by our 60s – you know, being 10 years from menopause, we’re talking about mostly women in their 60s – are going to have other medical conditions that we need to consider. And if you look at, I mean, there are certain things that estrogen, we know, helps with. So, whatever age of your life you start on estrogen, it’s going to help your bones. It’s not that it stops helping bones for women in their 60s.

So, yes, it will help prevent osteoporosis, there’s a good amount of evidence that it actually improves women who actually have osteoporosis, so that, we know that, that’s really not a debatable point.

It treats hot flashes whenever we try it for hot flashes that are due to menopause, estrogen is the first-line treatment. The part that’s more of a gray area and why we have that kind of 10-year guidance that we try to stick to is that after your body has adjusted to a long period of time of not having hormones present, certain changes occur in our vasculature, how the arterial flexibility and stiffness evolves. And reintroducing estrogen at that point after that has happened can have new deleterious effects, so new negative effects on the blood vessels, perhaps increasing cardiovascular risk. And the important area is that all of us are really interested in how to keep our brains functioning in the long term and in our later years.

So, we want to live longer, but we want to live longer with our cognition intact, right? And that’s the space where there’s been a few well-done studies showing that actually reintroducing estrogen has a negative impact on cognitive function. And for many people and for me myself, that is a scary thought that you could be introducing something that could have that impact. So, we definitely want more information, again, about this. And then the other caveat is women who were started on hormone therapy in that early phase and would like to continue through their 60s and beyond, that’s sort of a different category.

And that we feel much safer and more comfortable about because they’ve had estrogen present through that entire window. So, for them, unless they develop a contraindication or a reason to come off, that’s always a discussion, you know, “Do you want to continue? Do you want to taper down?”

But that patient who comes in who went through menopause at 52 and now she’s 65 and she heard about how great it is to be on hormones, for that person, you really have to make sure she has a good understanding of the pros and cons. And her cons may be more significant than we appreciate, and so we don’t want to minimize that. But there are still some pros even for her, she could certainly start on vaginal estrogen for her genitourinary symptoms, that we can start and stop at any point because it’s not systemic. And I wouldn’t say that it’s always a no, but it has to be really well thought-out and informed. I guess I would leave it at that.