Hormone Therapy Gains Acceptance Again as Risks Reassessed

For over two decades, hormone replacement therapy (HRT) faced significant scrutiny, leading to a dramatic decline in its use among menopausal women. The fears surrounding HRT stemmed from the findings of the Women’s Health Initiative in 2002, which linked the therapy to increased risks of heart attacks, strokes, and several types of cancer. Consequently, HRT usage plummeted from nearly one-third of menopausal women in 1999 to less than 5 percent by 2022. Recent expert reviews, however, have challenged these long-standing concerns, suggesting that the initial alarms were largely unfounded.

A critical re-evaluation of the original Women’s Health Initiative study indicates that many participants were over the age of 65, often more than a decade past menopause. Research shows that the effects of hormones vary significantly based on when they are initiated. Furthermore, the hormone formulations used in the study were outdated and included estrogen derived from the urine of pregnant horses and a synthetic progestin, medroxyprogesterone. This synthetic progestin was associated with the slight increase in breast cancer risk noted in the study, not the estrogen itself. In fact, women who used estrogen alone exhibited a lower risk for breast cancer.

Emerging evidence points to the safety of modern therapies. For instance, bioidentical micronized progesterone, commonly used today, has not been linked to increased breast cancer risk. Long-term studies conducted in countries such as France and the UK, involving women over more than 30 years, found no significant difference in breast cancer rates between those who used HRT and those who did not.

Updated Perspectives on Hormone Therapy

Concerns regarding blood clots and strokes were also primarily associated with oral estrogen, which can increase clotting factors when metabolized through the liver. In contrast, transdermal estrogen—administered via patches, creams, or gels—bypasses this process and significantly reduces the risks associated with clotting. Experts now advocate for transdermal methods as the preferred choice, highlighting their low risk profile.

With these updated understandings, many health professionals agree that the longstanding warnings attached to HRT products are outdated. The current consensus suggests that when hormone therapy is initiated within ten years of menopause and tailored to each individual, it can provide substantial health benefits. Some studies indicate that HRT may lower the risk of heart attacks and strokes by as much as 48 percent, nearly twice the effectiveness of cholesterol medications, which reduce risk by 22 to 27 percent.

HRT is also credited with decreasing fracture risk by 50 to 60 percent and is often well-tolerated compared to other medications like Fosamax, Actonel, or Prolia. For cognitive health, evidence suggests that hormone therapy may reduce cognitive decline by up to 65 percent, outperforming current dementia treatments. Additionally, low-dose vaginal estrogen can improve tissue health in the vaginal and urinary tracts, thereby reducing the frequency of urinary infections.

Women undergoing hormone therapy have been shown to enjoy a 63 percent lower risk of colon cancer and may experience enhanced immune function and a better capacity to combat infections.

Understanding Breast Cancer Risks

The reality is that one in eight women will develop breast cancer in their lifetime, regardless of hormone therapy use. For the majority, bioidentical hormone replacement therapy does not significantly elevate this risk. Even older synthetic progestins have been linked to only about one additional case of breast cancer per 1,000 women per year.

Moreover, women who undergo hormone therapy are often diagnosed at earlier stages, with more treatable cancers, leading to improved survival rates—averaging about two years longer. Many women also report enhanced mood, energy, cognitive function, and overall quality of life while on these therapies.

While certain groups, particularly those with obesity, insulin resistance, or a higher baseline risk of breast cancer, should carefully assess their individual risks, many women can safely consider hormone replacement therapy with proper medical guidance.

The significance of hormones extends beyond reproductive health. Hormones have receptors throughout various systems in the body, including the brain, bones, immune system, and more. A drop in hormone levels can result in a range of health issues. As noted by hormone expert Dr. Lindsay Berkson, “Without hormones, it’s as if your Wi-Fi is down—nothing works, and it’s incredibly frustrating.”

After nearly a quarter-century of mixed messages and fears, women are now receiving a clearer outlook on hormone therapy. When approached correctly, HRT is not only safe for most women but can also serve as a potent tool for promoting healthy aging and overall well-being.

Dr. Tereza Hubkova, MD, is board-certified in Internal Medicine and Holistic and Integrative Medicine, practicing at the InSpero Medical Center in Edwards.