Are You Afraid of Hormone Therapy?
19 Apr 2017

Are You Afraid of Hormone Therapy?

There’s good news on the horizon for the millions of women who are suffering with hormonal symptoms but afraid to take HRT. It’s been a long time coming…but the recommendations about what to use and how to use it (relative to estrogen therapy) are about to change.

The North American Menopause Society is updating the guidelines for hormone replacement therapy (HRT) that were last published in 2012. We’ve taken incremental baby steps since 2002 when the Women’s Health Initiative (WHI) study suggested that estrogen caused all kinds of problems including increased breast cancer risk, and higher risk of blood clots, heart attacks and strokes. When that was published millions of women were quickly taken off HRT and left to suffer.

What has followed since then is a cloud of fear around estrogen. Over the years, the data has been re-analyzed…with the finding that estrogen was NOT the culprit when it came to the problems that were identified. The “bad actor” was the synthetic progestin. Even so, many providers still believe that estrogen is dangerous and refuse to offer it as an option to their patients. This results in needless suffering.

The new recommendations, which will be published in July in the Menopause journal, represent some significant changes in thinking. Here are the highlights.

1. The statement that women should use the lowest effective dose of HRT for the shortest duration of time will no longer be valid. This was the standard of care statement that evolved from the WHI study.

2. It is recommended that women without a contraindication for HRT use it for 10 – 20 years post the menopausal transition. This is because it reduces the risk for heart disease and osteoporosis without increasing the risk for breast cancer.

Contraindications include a history of breast cancer, a previous blood clot, heart attack or stroke, active liver disease, unexplained vaginal bleeding, high-risk endometrial cancer, or transient ischemic attack.

Tweet: There’s good news coming for the many women suffering with hormonal symptoms but afraid to take HRT.

3. Transdermal estrogen is the preferred delivery method as it does not increase clotting factors and thus is not associated with increased risks for clots (DVT/PE, stroke, MI). Also this method optimizes changes in the lipid profile (lowers LDL/TG and increases HDL) and does not increase sex hormone binding globulin thus allowing for better bioavailability of testosterone.

4. Testosterone does not increase a woman’s risk for heart disease or breast cancer and should be considered as a component of post-menopausal HRT. The FDA did not approve testosterone replacement in women previously because of these two concerns.

These changes represent a step in the right direction in my opinion. The challenge will be getting information into the hands of the women who need it and their providers. How to start? Share this article!

Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Her clients would tell you that her real gift is helping them reclaim parts of themselves they thought were gone forever.

Find out more about working with her at


Dr. Anna Garrett


  1. Hey Dr. Garrett,
    I’m really enjoying your stuff. I’ve had severe menopause symptoms for as long as I can remember… 11+ years? My hot flashes I wouldn’t wish on my worst enemy and my mood swings, anxiety and fatigue are always off the charts. As much as I’d like to take something for my symptoms my mother had breast cancer. it was a very rare form of breast cancer supposedly no other woman has ever contracted and her doctors say there’s no chance if me inheriting it but still… nonetheless it terrifies me. I’ve never taken anything for my symptoms. I just suffer everyday and all day. I’d love to hear your thoughts on this.
    Warm regards,

    • Hi Cathy…thanks for writing. I understand your fear completely. My mom had breast cancer too (as did my sister). But there are things you can do to help that don’t involve hormones…like making sure your lifestyle is squeaky clean…avoid alcohol, processed foods, and compounds that act like estrogen in your body (pesticides, plastics, etc). There are also supplements that can be helpful depending on how close you are to menopause. I’d need to know more about you to make specific recommendations.


  2. Is there a subset of people that just can’t tolerate hormone therapy? I put on a very low dose patch and by the end of day had a splitting headache and was so incredibly tired I could not move or stay awake. My body tends to overreact to medications of any sort, but it seems odd to me that I had that sort of reaction to hormones. Am I just out of luck when it comes to HRT?


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