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Hormone supplements for women—yea or nay?

Created date

July 7th, 2017
A senior woman having a discussion with her doctor

Please have the discussion with your doctor about the specific symptoms you have and which treatments may be best for you.

Last month we reviewed the safety and effectiveness of testosterone supplements for men. This month, it’s time for the ladies to learn about estrogen, progesterone, and hormone supplements—commonly referred to as hormone replacement therapy, or HRT.

Today, HRT typically refers to a combination of estrogen and progesterone. These hormones are the primary sex hormones in women, and with age your body drastically decreases production of both.

Since the 1950s, HRT has been used primarily and effectively to treat symptoms of menopause such as hot flashes and vaginal atrophy. Early on, it was in the form of conjugated horse estrogen (yes, you read that correctly), and the medical community believed that it could help prevent chronic conditions such as heart disease, osteoporosis, and dementia-related illness. However, in 2002, a large women’s health study changed the prescribing practices for HRT. The study found that HRT was associated with a significantly higher risk of developing blood clots, strokes, and certain forms of breast cancer in addition to earlier findings that estrogen was associated with an increased risk of uterine cancer. 

Risks rise with age

The story has become even more complex in recent years with risks of HRT rising as you age. Currently, HRT is considered a reasonably safe option only for women within ten years of menopause, or younger than age 60 who are healthy and not at increased risk for breast or uterine cancer, cardiovascular disease, blood clots, stroke, or liver disease. For women with an intact uterus, progesterone should be added to the regimen to reduce the risk of uterine cancer associated with estrogen. Now, lower doses of more effective forms of HRT (including skin patches) are being prescribed, but in general, HRT should not be used for more than five years because of an increased risk of breast cancer.

Another option for women whose symptoms are primarily vaginal dryness and pain with intercourse is low-dose vaginal estrogen treatment. This local treatment comes in many forms, including creams, inserts, or rings, all of which are considered safer than systemic treatment because there is minimal absorption of the hormone into the bloodstream.

Finally, it is important to note that there are other medicines and also plant-derived estrogens and herbal remedies that have been used with varying levels of success for treatment of menopausal symptoms. The medicines primarily include antidepressants, and the plant derivations include food types from soybeans to chickpeas to lentils. Some believe that plant or biosimilar hormones are a better, safer option, but there is a lack of scientific evidence to support this or to show that these products are effective. 

Similar to testosterone considerations for men, the decision about HRT for women is complex, and benefits and risks must be weighed carefully. Please have the discussion with your doctor about the specific symptoms you have and which treatments may be best for you. If you are currently taking HRT, be sure to review its appropriateness at your next visit as risks rise with age and duration of use. 

Dr. Narrett leads the medical team at all Erickson Living communities. A graduate of Harvard Medical School, he has been providing care for seniors for over three decades.