Are Hormones Right for You? HRT Contraindications
Hormone replacement therapy (HRT) isn’t easy to understand. Some women consider it a miracle. Other women find it miserable. And for many women, it takes a lot of research, consultations and careful thought before they can even commit to trying it. HRT is not a slam-dunk cure-all for the symptoms of menopause or hormonal imbalances. There can be many contraindications – specific situations in which HRT is not advisable because of health history and the potential risks.
HRT – Who Should Not Take a Chance?
Women who have or previously had a stroke, ovarian cancer, breast cancer, endometrial cancer or blood clots in the legs or lungs should usually not take hormone therapy. There are some cases in which HRT could trigger or exacerbate a health issue or even put a woman’s life at risk. Some of these conditions include:
- Undiagnosed abnormal vaginal bleeding
- Suspected or active breast or endometrial cancer
- Active liver disease with abnormal liver function tests
- Porphyria cutanea tarda – a blood disorder
- Active thromboembolic disorder
- Acute-phase myocardial infarction
Who Should Consider Hormone Therapy?
Of course, there are many women for whom the benefits of HRT far outweigh the risks. Women experience a drop in estrogen levels at an early age, such as those who experience early menopause or who have had their ovaries removed, are usually advised to begin HRT to help lower their risk of several health conditions, including:
- Heart disease
- Earlier death
- Parkinson’s-like symptoms (parkinsonism)
- Anxiety or depression
What are the Risks of Hormone Therapy?
Your health history, age and time since menopause play significant roles in the risks associated with hormone therapy. Women who start HRT more than a decade after menopause or after age 60 may be at higher risk for certain dangerous conditions, including:
- Heart disease
- Blood clots
- Breast cancer
The risks of HRT can depend on whether estrogen is given alone or with progestin, the dosage and delivery.
Cancer Risks and HRT
Women who have had breast cancer and risk recurrence or who are at high risk for breast cancer may see those odds increase while using some types of HRT. Breast cancer in women taking estrogen and progestin (EPT) are more likely to be found later, when they are bigger and have spread. This may be caused by EPT’s link to increased breast density, which can make it more challenging to spot breast cancer on a mammogram.
However, using systemic EPT can increase the risk of endometrial cancer for women who still have a uterus. The risk remains elevated even after HRT is discontinued. Using EPT has been shown to have no increase in endometrial cancer risk. Based on your family history and health history, HRT and the type of HRT used can positively or negatively impact the occurrence or progression of ovarian cancer, colorectal cancer and lung cancer.
How Can You Reduce the Risks Associated with HRT?
If you started menopause after age 45 and are not experiencing severe symptoms, you probably don’t need hormone therapy to stay healthy. Instead, consider options that will reduce your risk of specific conditions such as heart disease and osteoporosis. But a prudent and minimal use of the right delivery method and formula is the best way to ensure the benefits outweigh potential problems.
- Discuss the benefits of bioidentical hormone creams with your doctor. When you discuss your specific concerns and health history with your urogynecologist, they will be able to assess what kind of hormone options will best suit your needs. Here at Coyle Institute, we use only bioidentical hormone creams. We believe this is the safest and most effective delivery system for our patients. There are other delivery methods used my other practices, so you need to understand why we believe in the cream delivery method. Estrogen can be taken in the form of a cream, but other practices use the vaginal ring, pill, patch, gel or slow-releasing vaginal suppository. Before you make a decision, a consultation with one of our specialists at the Coyle Institute will help you understand the benefits and contraindications of all delivery methods.
- Use the lowest effective dose. If you aren’t getting the results you want, you can discuss increasing your dosages.
- Only use HRT as long as you have to. It is recommended that you only use HRT as long as you need it to manage menopausal symptoms. Women who begin menopause before age 45 may be advised to use HRT for a longer period to protect them from osteoporosis, heart disease and other conditions related to the long-term effects of low estrogen.
- Work on your overall health. Exercise, eat a healthy diet, maintain a healthy weight, manage your stress and don’t smoke! The better care you take of yourself, the better results you’ll get from HRT.
- Follow up with your urogynecologist. HRT is not a one-and-done treatment. After you have started HRT, your urogynecologist will want to follow up with you at regular intervals to make sure your specific treatment is doing what it needs to do for you and to monitor any changes in your health that may require an HRT overhaul. If you are experiencing side effects, weight loss or gain, moodiness or anything that indicates to you that your hormones may need a little tweaking, let your physician know. If you experience abnormal bleeding or are undergoing testing for cancer, alert your provider immediately so they can assess the impact of your HRT and whether or not it should continue or change.
What Can You do if You Can’t Use Hormone Therapy?
You may be able to manage some menopausal symptoms with lifestyle changes. Women who are experiencing vaginal pain or dryness during intercourse can use an over-the-counter vaginal moisturizer or lubricant as a first step toward finding relief. There are also non-surgical treatments, such as diVa® laser vaginal rejuvenation, that can help with vaginal symptoms and help menopausal and post-menopausal women find relief from urinary incontinence.
Is HRT right for you? It will take an in-depth conversation and even hormonal testing to determine the root of your health issues and the best course of correction. Schedule your consultation with the expert women’s health team at Coyle Institute and get the answers and treatment that will work for you!