The Truth About Hormone Replacement Therapy

Written By Ann Konkoly

Let’s Start With the Evidence

Confusion about menopausal hormone therapy (MHT) and hormone replacement therapy (HRT) is common — and for good reason. Over the past two decades, public perception has been shaped by outdated research headlines, incomplete interpretations, and conflicting guidance.

A recent review by Barbara S. Levy, MD, published in The Lancet Diabetes & Endocrinology, offers a clear, modern understanding of MHT, helping clinicians and patients alike make more informed decisions.

The Importance of Timing — and the Truth About the WHI

In 2002, the initial results of the Women’s Health Initiative (WHI) hormone therapy trial were released — not in a peer-reviewed journal first, but at a nationally televised press conference. This was an unprecedented move for a clinical trial, especially one involving millions of women’s health decisions.

The press release and media headlines focused on an increased risk of breast cancer, heart disease, and stroke, without proper context. What was left out? Most of the women in the study were well past menopause (they were, on average, age 63 when started on synthetic hormones), and the data actually showed that women closer to menopause had a very different — and often favorable — risk profile.

By the time more nuanced analyses were published, the damage had been done. Women and clinicians around the world were led to believe that all menopausal hormone therapy was dangerous — and millions stopped therapy overnight. This shift has had lasting health consequences, including increased rates of osteoporosis, fractures, and possibly cardiovascular disease, not to mention decades of unnecessary suffering from hot flashes, insomnia, and other symptoms.

Even experts like Dr. Rachel Rubin, in a recent interview on Peter Attia, MD’s The Drive podcast, have emphasized how profoundly the WHI’s rollout misled the public. Many in the menopause field believe it remains one of the most damaging miscommunications in women’s health — a scenario worthy of a Hollywood drama given its scale and impact.

Today’s research paints a far more accurate picture:

  • Timing matters — Starting menopausal hormone therapy before age 60 or within 10 years of menopause is generally associated with significant benefits and minimal risks for most women (and can also be appropriate for women beyond the age of 60).

  • Individualized decisions are key — For women starting later, hormone therapy can still be considered with careful risk–benefit assessment.

The Benefits of HRT

Evidence supports HRT as an effective intervention to:

  • Relieve vasomotor symptoms — Including hot flashes, night sweats, and associated sleep disturbance.

  • Improve quality of life — By supporting mood, cognition, and daily functioning in symptomatic women.

  • Protect bone health — Reducing the risk of osteoporosis and related fractures.

  • Support metabolic health — In appropriate candidates, MHT may have favorable effects on certain cardiovascular and metabolic markers.

Factors That Influence Safety

  • Route of administration — Transdermal estradiol (patch, gel, spray) is associated with a lower risk of venous thromboembolism (blood clot) compared to oral, synthetic estrogen.

  • Type of progesterone — Bioidentical micronized progesterone appears to have a more favorable safety profile for breast and cardiovascular health than certain synthetic progestins.

  • Customized approach — Age, health history, symptom profile, and personal preferences all influence the safest and most effective regimen.

The Kultivate Women’s Health Approach

At Kultivate Women’s Health, we integrate the latest research with each patient’s unique health profile to determine whether HRT is an appropriate option. The goal is to optimize symptom control, preserve long-term health, and minimize risk through individualized treatment planning.

Considering Hormone Replacement Therapy?

Schedule a consultation today: www.kultivatewomenshealth.com/visit

Reference
Levy, B. S. (2023). A contemporary view of menopausal hormone therapy. The Lancet Diabetes & Endocrinology, 11(10), 734–746. https://doi.org/10.1016/S2213-8587(23)00158-9

Ann Konkoly