Assessing Your Health Risks and the Role of HRT

The IOM recommends against routine use of HRT but says women should confer with their doctors to determine the best course of treatment based on their individual risk factors and preferences. The information below, however, may help you take a clear look at the possibilities offered by HRT vis-à-vis the health conditions that post-menopausal women are at increased risk for developing:

  • Heart Disease: “If you initiate HRT within about one year of developing menopausal symptoms, it’s actually cardio-protective,” says Anne Ford, MD, Ob-Gyn at Duke University Medical Center. Other studies suggest, however, that estrogen is beneficial only if you have healthy arteries; if your arteries are already clogged (a common issue for women over age 60), estrogen may do more harm than good. Research also indicates that prolonged or later use of HRT may cause an overall increase in heart disease risk.
  • Breast and Uterine Cancer: Rising estrogen levels increase the risk of breast, endometrial, and uterine cancer, which may be a concern for women who choose to take HRT. If you have a family history of any of these cancers, HRT may still be an option, but only when other approaches for managing menopause symptoms fail.
  • OsteoporosisBecause estrogen circulating in your body helps control bone loss, losing estrogen means losing bone mass. The best way to prevent osteoporosis: Reach peak bone mass before menopause begins by exercising regularly (weight training is key) and consuming a healthy diet rich in calcium, vitamin D, and magnesium.
  • Sexual Dysfunction: During menopause, the structure of the vagina physically changes. Tissues become thinner, more delicate, and less elastic — and that can make sex uncomfortable, even with appropriate lubrication. “Regardless of your libido, if sex is painful for you over time, you’re not going to want to have it,” says Ford. The good news: Treating the problem with topical estrogens can reduce vaginal atrophy and relieve dryness, which can have a dramatic impact on your quality of life.

The Bottom Line: Finding the Right Balance

Managing the hormonal fluctuations that take place during menopause can be quite a challenge. Too little estrogen may increase the risk of osteoporosis and possibly some forms of heart disease, but too much estrogen may increase your risk of breast, uterine, and endometrial cancer. Reaching an appropriate balance — with the help of your healthcare provider — is key to menopausal health and wellbeing.