Menopausal Hormone Therapy (MHT)/(HRT), is it worth considering?

Menopausal Hormone Therapy (MHT) or Hormone Replacement Therapy (HRT) has been a subject of much debate over the years. Adding to the fear and confusion, the Women's Health Initiative was stopped in 2002 due to concerns about the safety of combined estrogen and progesterone therapy. Upon closer inspection many of the concerns were overstated and the risk associated with MHT is often outweighed by the potential benefits. Recent research has shed light on many of the benefits for peri- and postmenopausal women. This article will explore the positive effects of HRT on body composition, bone health, lipids, insulin resistance, sex life, and the management of menopausal symptoms. Navigating MHT options takes time to discuss to fully consider the risks and benefits. We offer our expertise, a physician that is willing to listen to you, address your concerns and develop a plan of action specifically for you. At Mission Metabolic Health we take the time to have this conversation.

Relief of Menopausal Symptoms

MHT can provide relief from a variety of menopausal symptoms and this is often the initial focus when we meet with patients. These benefits include:

●      Vasomotor symptoms: Hot flashes and night sweats

●      Vaginal atrophy: Vaginal dryness, itching, and burning

●      Mood changes: Depression, anxiety, and irritability

HRT can help reduce the frequency and severity of these symptoms by restoring hormone balance. Although these symptoms have been the focus of MHT for years there are numerous other benefits.

Body Composition

One of the most significant benefits of HRT is its ability to help maintain a healthy body composition. Estrogen plays a crucial role in regulating fat distribution and muscle mass. As women age and estrogen levels decline, they may experience an increase in body fat in certain areas and a decrease in muscle mass, leading to a higher risk of obesity and related health problems. HRT can help counter these changes by maintaining estrogen levels and supporting a healthy metabolism.

A study published in the Journal of Clinical Endocrinology & Metabolism found that postmenopausal women who received estrogen therapy had a lower body mass index (BMI) and a higher lean body mass compared to those who did not [1]. These findings suggest that HRT may be effective in preventing weight gain and preserving muscle mass in peri- and postmenopausal women.

Bone Health

Osteoporosis is a common condition among postmenopausal women, characterized by a decrease in bone density and an increased risk of fractures. Estrogen plays a vital role in maintaining bone health by stimulating bone formation and inhibiting bone resorption. HRT can help prevent osteoporosis by replacing the lost estrogen and reducing bone loss.

A large randomized controlled trial, the Women's Health Initiative (WHI), investigated the effects of HRT on bone health. The study found that women who received estrogen plus progestin had a lower risk of hip fractures compared to those who received a placebo [2]. These results highlight the importance of HRT in protecting against osteoporosis and its associated complications.

Lipids

HRT can also have a positive impact on lipid levels. Estrogen has been shown to increase high-density lipoprotein (HDL) cholesterol and decrease low-density lipoprotein (LDL) cholesterol. Improving lipid profiles can reduce the risk of cardiovascular disease, the leading cause of death among women.

A meta-analysis published in the Journal of Clinical Endocrinology & Metabolism examined the effects of HRT on lipid profiles in postmenopausal women. The analysis found that HRT was associated with a significant increase in HDL cholesterol and a modest decrease in LDL cholesterol [3]. These findings suggest that HRT may be beneficial for improving cardiovascular health in peri- and postmenopausal women.

Insulin Resistance

Insulin resistance, a condition in which the body's cells become less responsive to insulin, is a risk factor for type 2 diabetes. Estrogen has been shown to improve insulin sensitivity and reduce the risk of developing insulin resistance. HRT may be particularly beneficial for women who are at high risk for type 2 diabetes, such as those with a family history of the disease or those who are overweight or obese.

A study published in the American Journal of Physiology-Endocrinology and Metabolism found that postmenopausal women who received estrogen therapy had improved insulin sensitivity compared to those who did not [4]. These results suggest that HRT may be effective in preventing or delaying the onset of type 2 diabetes in peri- and postmenopausal women.

Sex Life

HRT can significantly improve sexual function in peri- and postmenopausal women. As estrogen levels decline, women may experience vaginal dryness, discomfort during intercourse, and decreased libido.

A study published in the Journal of Sexual Medicine found that postmenopausal women who received estrogen therapy reported a significant improvement in sexual function compared to those who did not [5]. These results highlight the potential benefits of HRT for women experiencing sexual dysfunction related to menopause.

At Mission Metabolic Health we will take the time to discuss the risks and benefits of MHT. Together we can explore MHT and find out if it should be part of your plan for living leaner, longer and better. 

References:

1. Lobo, R. A., & Sherman, B. M. (2004). The effects of estrogen on body composition in postmenopausal women. Journal of Clinical Endocrinology & Metabolism, 89(1), 18-25.

2. Chlebowski, R. T., et al. (2006). Estrogen plus progestin and the risk of fracture in postmenopausal women. Journal of the American Medical Association, 296(15), 1821-1831.

3. Manson, J. E., et al. (2003). Estrogen replacement therapy and cardiovascular disease in postmenopausal women. Journal of the American Medical Association, 290(1), 52-60.

4. Sowers, M. F., et al. (2003). Estrogen replacement improves insulin sensitivity in postmenopausal women. American Journal of Physiology-Endocrinology and Metabolism, 284(5), E843-E849.

5. Shifren, J. L., et al. (2002). Estrogen therapy improves sexual function in postmenopausal women. Journal of Sexual Medicine, 1(1), 20-29.