Ask Barbie! Barbara Taylor MD's Q&A addressing your burning questions about Menopause

Ask Barbie:Can I take Hormone Replacement Therapy for a Long Time?

If Not, When Should I Stop It?

The Basic Science of Hormone Deficiencies

The answer to this question goes back to the very basic science of hormone deficiencies. For every hormone that your human body produces, there are several consequences for deficient quantities of the hormone. The basic science of hormone deficiencies is this:

  • Every hormone deficiency produces symptoms that are your body’s attempt to get your attention and make you aware of the hormone deficiency.
  • Every hormone deficiency results in fatal diseases if you do not adequately replace the hormone.
  • Every hormone deficiency requires you to take hormone replacement for the rest of your life.

Well, hormone replacement therapy for menopause is hormone replacement for a vital hormone that functioned as your fountain of youth. That hormone is a type of estrogen called “estradiol.” And, by definition, once you lose your estradiol at the time of menopause, you will live the rest of your life as a menopausal woman. Another way to state this is to say that you will live the rest of your life with a hormone deficiency.

Taking HRT for “A Long Time”

So what’s “a long time?”

Most women encounter menopause in their 40s or 50s. But the average life expectancy for women is 76 years. This means that most women will live one third to one half of their lives with estradiol deficiency. And, if they were to omit hormone replacement therapy, they would live the last one third to one half of their lives in a hormone deficient state.

This also means that any symptoms that are due to the hormone deficiency will continue for that lengthy period of time. Additionally, it means that any diseases that result from the hormone deficiency will present risks for that lengthy period of time.

Fear versus Logic

Well, unfortunately, the world of menopause and hormone replacement therapy for menopause is enshrouded with fear. Instead of resorting to logic, people react to fear. 

I think it’s always better to address things logically.

Insulin Deficiency and Estrogen Deficiency

The best way to understand the answer to our question today is to pose our question with regard to insulin rather than to estrogen.

If your pancreas stopped producing insulin, you would have insulin deficiency. This is also known as diabetes. If you had insulin deficiency, how long would you take insulin? Would you worry about taking it too long? Would you think there’s some age limit at which you’re supposed to stop taking it? And if you stopped taking your insulin, what would happen?

All that’s necessary to answer our question about taking menopause HRT for a long time is to substitute the word “insulin” for the word “estrogen.” In terms of the basic science of hormone deficiencies, there is no difference. The only difference is fear. There is no fear associated with insulin replacement for insulin deficiency. But there is irrational fear associated with estrogen replacement for menopause.

Women’s Health Initiative (WHI)

The fear associated with hormone replacement therapy for menopause comes from one single study published in 2002. It was the Women’s Health Initiative, which was rife with flaws. However, it was a very large and very expensive study. And it got the most media attention of any study in the history of medicine. So its completely false and erroneous results made the news worldwide.

And the result was rampant fear worldwide. Women everywhere immediately flushed their hormone replacement therapy down the toilet. It was the flush heard around the world.

Well, fear is the most powerful emotion on earth. It is very difficult to erase it or reverse it. And that one study, and its fearful media attention, have lingered ever since. Not only have they lingered; they have governed all the guidelines for menopause hormone replacement therapy ever since.

The WHI study was supposed to last for over eight years. However, the researchers used a dramatic arrest of the study as a fear-mongering tool. So it only studied women over a five-year period of time. Five years is a lot shorter than the one third to one half of a lifetime that most women will endure menopause.

Nevertheless, the WHI study results became extrapolated to real women’s lives. And, as the result of the fear that took place five years into the WHI study, the guidelines have been designed according to the WHI study.

Taking HRT for the“Lowest Dosage, Shortest Time”

The guidelines for menopause management indicate taking HRT “at the lowest dosage for the shortest time.”

Have you ever heard a diabetic say they’re going to take their insulin at the lowest dosage for the shortest time? Does it make any sense to you?

Well, because of the short time of the WHI study and its alarming fearful results, most doctors and women have the assumption that they should only take menopause HRT for a short period of time, and then stop it.

But that creates a big problem: Taking menopausal hormone replacement for a short time will alleviate symptoms only while you’re taking it. And it will prevent the onset of the three fatal diseases of menopause only while you’re taking it.

And when you stop HRT for menopause, your symptoms of menopause will resume. Not only that; Your risks for the three fatal diseases of estrogen deficiency (which are heart attack, osteoporosis, and Alzheimer’s) will increase significantly.

Likewise, if a diabetic stopped taking insulin, their symptoms of insulin deficiency would resume and their risk of dying from kidney failure would increase significantly.

The science on all of this is very sound. The only difference between insulin and estrogen is fear.

The Answer: Of Course You Can

So the answer to the question, “Can I take menopause HRT for a long time?” is: Of course you can! You can take it until the day you die, just like you would any other hormone replacement. It makes no sense whatsoever to stop. Ahh, but, such is the power of fear.

Going back to basics, thinking about this logically, and using insulin as example makes the answer to our question very easy.

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