| Hormone Replacement Therapy in Women: Just the Facts, Ma’am By L. William Lauro , MD A few years ago I wrote health articles for Meridian Magazine on a regular basis. However, when I received a calling in 2007 to be the physician at the Temple Square Clinic in Salt Lake City , I found myself too busy to continue writing. Despite this I never lost my interest in Meridian and I read the articles regularly. Most are superb. Recently, however, I read an article in Meridian on female hormones and I found myself disagreeing with some of the statements and suggestions made by the author. I was concerned that the article could potentially cause some unnecessary confusion and misunderstanding for many women regarding this extremely important topic. So, in response, I wanted to write what I consider to be an accurate, up-to-date article on the subject, hoping that much of the misinformation (and inaccurate personal opinions) floating around out there could be put to rest. I am not compensated for my opinion, I do not have a medical practice that profits in any way by the treatment of menopause in women, I do not own stock in any drug companies, nor do I receive any compensation or gifts from them. I currently practice medicine for free for the Church, and in the past have served as an Adjunct Professor of Family Medicine at the University of Utah College of Medicine. Menopause, Symptoms, and Hormone Replacement Therapy You have heard these terms before but what exactly is going on? It is really pretty simple. Women who are in their late 40’s or early 50’s begin to experience specific symptoms related to the declining endocrinologic function of their ovaries. Simply put: their estrogen levels begin to drop. Now, I am not a woman so I cannot tell you how these symptoms feel, but I did go to medical school and I do have a wife who is now 49 and experiencing many of the symptoms herself. And if you are of menopausal age, you can probably relate to many (if not all) of the following symptoms:
Did I miss any you would like to add? Hormone replacement therapy specifically means giving a woman the estrogen she is now lacking. It does not mean giving the woman progesterone, a female hormone of pregnancy, a hormone which specifically exists to stabilize the proliferative endometrium in anticipation of implantation of the fertilized egg in a fertile, pre-menopausal woman. It does not have anything to do with treating menopause symptoms. In fact, it is only used when a woman with an intact uterus is given estrogen so as to prevent endometrial proliferation caused by the estrogen itself, which can lead to cancer of the uterus. Again, it has no proven beneficial effect on menopausal symptoms per se. Now, I know I am stepping on a lot of toes out there because many people (practitioners and patients alike) believe in progesterone replacement for menopause. But at the outset of this article I promised to give you just the unbiased facts, so there it is. Study after study has found that progesterone alone has no beneficial effect on menopausal symptoms and furthermore has no beneficial effect on a women’s long-term health (it can, in fact, be detrimental). Estrogen (estradiol, estrone, etc) is the key female hormone, but it too can have serious risks when given to a menopausal woman (more on that below). Confusion, Controversy So, if the physiology is pretty straightforward, and the studies pretty certain, why all the confusion and controversy regarding the treatment of menopause? One big reason is that many menopausal symptoms can be caused by other maladies as well and thus might not be specifically related to menopause itself. Therefore, if a woman goes to her doctor and gets hormone treatment (i.e. estrogen) to treat what is thought to be a menopausal symptom, and does not see improvement, she might wrongly conclude that the hormone treatment prescribed does not work when, in truth, the wrong diagnosis has possibly been made. Thus the woman might believe that traditional hormone replacement has failed her. Some examples: Fatigue. Yes, menopause can cause extreme fatigue. But so can many other illnesses, for which estrogen does not work. Mood changes, depression? Yes, menopause can cause this, but what happens if your mood problem is not from menopause but something else? Hormones are not going to help. And what about declining sex drive? Do you know how many women have decreased libido that is not caused by (nor helped by) hormones? Ya, a lot. Are you getting the picture? The poor woman in the above scenario, who truly believes that all of her symptoms are caused by hormone problems (imbalance, deficiency, etc) concludes that traditional therapy has failed her and thus embarks on a hunt for “the cure” from another practitioner, a prescriber of “non-traditional” therapy who claims it works better than the run-of- the-mill stuff she has already tried. Unfortunately this woman has now entered the area of unproven therapies , which abound in the community simply because they are very lucrative for the practitioner, not because they are especially effective. I know my opinion sounds harsh, but so much of what is available for the unsuspecting woman in this scenario has not been shown to be effective when put to the test of rigorous clinical studies. What are some of these non-traditional therapies? They include plant estrogens (phytoestrogens), natural progestins and progesterone, hormone-related natural herbs, and the newest and most expensive approach: bioidentical hormones (compounds not regulated by the FDA, compounds not approved by the American College of Obstetrics and Gynecology–ACOG, compounds formulated by an individual practitioner who swears his formulation is the best on earth). Now, before you start flooding my email with testimonials about how your specific formulation worked when others did not, remember that many of these clinical success stories can result from the placebo effect, an effect which is quite powerful. Please note that I did not just say that all women who get better on non-traditional therapies are placebo junkies. It is simply the opinion of most scientists in this field that many people who get better on these therapies, which have failed to prove effective in rigorous clinical studies, are probably experiencing a placebo effect. You might say, “Well, if it works for me I could care less if it is a placebo effect.” And I would not fault you for wanting to continue your therapy, provided you are not paying too much money for it and provided you are not doing anything dangerous or risky. But please consider the bigger problem: you take a non-proven treatment; you feel better (for a while at least); you spend a lot of money and effort getting the treatment; you expose yourself to chemicals you probably do not need; you potentially lead yourself away from the correct diagnosis by continuing along this unproven path; you then tell your neighbors and friends about it-they want it too. It drives up the cost for everyone, and it exposes many people to chemicals they do not need and to which they may adversely react. Again, I am not necessarily telling you specifically to quit your therapy, I am simply saying that generally it is much better to stick with reputable science rather than the personal testimonials of your neighbor or some slick advertisement you see on cable TV. The other area of confusion surrounds the revelations brought about by the now famous Women’s Health Initiative Study. Before this landmark study physicians believed that estrogen replacement therapy was wonderful-it treated hot flashes (true); it helped fatigue and mood problems (true); it helped some hormone-related insomnia (true); it helped some cases of declining libido (true); it helped prevent osteoporosis (true). But it was also believed to do much more: reduce heart attack and stroke in women ( not true, actually can increase both); reduce breast cancer ( not true, can increase risk); reduce the chance of Alzheimer’s Disease (not true, no significant help at all); and overall prolong a woman’s life (just the opposite-it was found to decrease longevity in women due to blood clots, heart attacks and stroke). These results were shocking and changed the way we use hormones in menopause. While some practitioners cling to the old ways, most clinicians have completely changed their approach to menopause. Conclusion–What to do: So, if you are experiencing menopausal symptoms, what should you do? Based upon the best known data as of 2009 I offer this advice (advice which is sanctioned by ACOG and the US Task Force on Preventative Medicine):
But what if I am afraid of taking estrogen? What about those natural “safe” plant estrogens or the natural herbal remedies or special women’s vitamins? There simply have not been enough studies to tout them as totally safe nor completely effective. Now, I would never fault anyone for trying these compounds over traditional estrogen. It seems logical to me to go ahead and try something less powerful and potentially safer than estrogen replacement for menopausal symptoms. And if it works for you and does not cost too much, you are ahead of the game. I am simply saying that in most studies so far, they have not been particularly effective and we still do not know if they are potentially risky like long-term estrogen has proven to be. But what should I do if I try estrogen and do not feel better with my fatigue, or moodiness, or sex drive? Should I go to one of those clinics that advertise bioidentical hormones, the ones the movie stars take? It is up to you. I do not believe they are harmful per se; they simply have not proven effective in clinical studies performed by the large, reputable medical centers in this country, and they are very expensive. If the traditional hormone therapy did not work for you, please investigate other possible causes of your symptoms. Also, we have some pretty good non-estrogen therapies for these symptoms these days. Talk to your doctor about SSRI’s or anti-seizure meds which seem to work for menopausal symptoms.
I hope this article has been helpful. I have tried to make it as accurate as modern medicine knows at this point in time. If things change I will try and write an update. But for now I am heading back to Temple Square . Good luck. No Comments | Post or read comments FEATURES |
May 14, 2026
May 14, 2026
