How Long Can You Take Hormone Replacement (HRT) Safely?

How Long Can You Take Hormone Replacement (HRT) Safely?

by bayres

Hormone replacement therapy is oftentimes an effective solution for men and women struggling with symptoms of hormone imbalance related to aging or certain conditions and diseases. Hormone therapy is one of the most effective treatment options for hormone imbalance when administered under the care and guidance of a highly-trained medical practitioner.

The safety and efficacy of hormone replacement therapy is largely dependent on the medical team you choose to partner with for your treatment plan. There is no one-size-fits-all plan—the length of time that you can safely supplement hormones varies by patient and the condition being treated. Discover how to make the best choice for your health.

What Is Hormone Replacement Therapy (HRT)?

Hormone replacement therapy (HRT) is supplementation of exogenous hormones to treat hormonal imbalance. Therapy is available in a variety of forms and delivery methods. Perimenopause and menopausal symptoms in women are among the most commonly diagnosed conditions of hormone imbalance that are frequently treated with estrogen and progesterone therapy—examples of hormone replacement therapy. Andropause, or low testosterone in men, is another frequently diagnosed condition of hormone imbalance that is treated with testosterone therapy, another example of HRT. However, thyroid disorders and adrenal fatigue, among other conditions may also be treated with hormone replacement therapy.

If you believe hormone replacement therapy might be right for treating your symptoms, and conditions of hormone imbalance, your journey will begin with comprehensive lab testing. Following return of your lab results, your medical doctor will review your case, including lab results, medical history, symptoms and lifestyle. This information will allow your physician to recommend the safest, most effective therapy options for you and develop a comprehensive treatment that will meet your needs.

What is Bioidentical Hormone Replacement Therapy (BHRT)?

Over the last 20 years, bioidentical hormones have become one of the most popular forms of hormone therapy. The widespread prevalence of bioidentical hormone replacement therapy (BHRT) is linked to the safety and effectiveness when treating symptoms of hormonal imbalance in men and women.

Unlike synthetic hormones, bioidentical hormones are derived from naturally-occurring sources, such as soy or yams, and compounded into the forms and doses prescribed by a qualified practitioner. The term “bioidentical” refers to the exact-match structure to human endogenous hormones. This identical replication reduces side effects and risks, as well as enhances the effectiveness of the treatment.

Bioidentical hormones are compounded at compounding pharmacies. Compounding pharmacies operate under FDA-established standards for safety and quality. Compounded hormones are specially made by a compounding pharmacist in the precise strength and dosage as prescribed by the attending practitioner. Because doses are carefully determined after an experienced and highly-trained hormone therapy practitioner, bioidentical hormones cannot be patented or made into mass prescription forms by large pharmaceutical companies—in most cases.

To ensure paramount safety and effectiveness of BHRT, your practitioner will meet with you to review and discuss your medical history, symptoms, lifestyle and lab results. This information ensures that you get a treatment plan and prescriptions that meet the unique needs of your body. Hormonal balance is not achieved by meeting some universal standard of normal—balance is reached when optimal function is restored for you, as an individual.

Research on Hormone Replacement Therapy

Hormone replacement therapy dates back to the 1930s, including use of bioidentical hormones. Despite the long history of the treatment, research was limited until just before the turn of the 21st century, when one of the largest studies ever conducted on hormone therapy was initiated. The Women’s Health Initiative (WHI)1 began in 1991 to determine the effects of menopausal hormone therapy on women’s health. One arm of the study hypothesized that estrogen or estrogen-progesterone therapy would reduce the risk of heart disease and fractures in women. The study used o-estrogen and progestin—synthetic forms of each hormone.

This arm of the WHI study was halted early in 2002 when a number of subjects on estrogen or combination estrogen-progestin therapy were observed to have an increased risk of breast cancer, stroke and heart disease. For years, this outcome haunted patients and physicians—hormone therapy earned a dangerous reputation and left women without an effective treatment for the symptoms of menopause. However, over the last two decades doctors and researchers have carefully reviewed the study data, finding that the study methodologies were flawed and that the form of hormone therapy used—synthetic hormones—along with the advanced age of the trial participants contributed to the negative outcomes.

The Heart and Estrogen-Progestin Replacement Study (HERS)2 study, published in 1998, examined the risks associated with long-term use of hormone replacement therapy in women with coronary heart disease. The initial results uncovered evidence that HRT increased the risk of heart attack and stroke by 50 percent in the first year for participants. However, after two years of therapy participants experienced a 35 percent reduction in incidence of cardiovascular events. In 2004, the estrogen-only group was forced to shut down because results indicated an increased risk of blood clots, stroke, and heart attack.

Since then, it has become well-understood that prior risk of disease and age play a role in who is or is not a candidate for hormone therapy and how long the patient may safely be treated with HRT.

In 2017, the results of large, long-term study on women and hormone therapy were published in the Journal of the American Medical Association (JAMA)7 that eschewed previous findings. The study followed more than 27,000 women for nearly 18 years. The women who were randomly assigned to hormone replacement therapy for a median of six to seven years were no more or less likely to die of any cause that women taking the placebo. This news led the North American Menopause Society to approve the conclusive recommendation of the study, “…for most women who initiate hormone replacement therapy under 60, or within 10 years of reaching menopause, it’s safe and can improve quality of life, increase productivity and reduce medical expenditures linked to untreated symptoms of menopause.”

Practitioners and medical organizations have used these studies to make appropriate recommendations for patients seeking hormone therapy. As mentioned, hormone therapy is not a one-size-fits-all treatment option, but it is safe and effective when properly prescribed to eligible patients.

In fact, today, at least 10 major medical organizations recognize hormone replacement therapy as the most effective treatment option for symptoms of menopause, including hot flashes, night sweats, insomnia, weight gain, and mood swings. When administered under the guidance of a highly-trained medical practitioner, hormone therapy can be a safe and effective treatment for an array of symptoms and conditions that result from a hormonal imbalance.

Among the improvements in safety and effectiveness is the research conducted on bioidentical hormones. Bioidentical hormone therapy (BHT) has been gaining traction in academia in recent decades. Many small research projects3,4,5,6  have been conducted on the efficacy of bioidentical hormones, finding that for symptoms, such as hot flushes, low sex drive, mood swings, anxiety and irritability, bioidentical hormones are safe and effective when administered under the care and supervision of medical practitioner. BHT reduces the risk of adverse clinical outcomes related to cardiovascular, breast, bone and brain health when compared to synthetic hormones.5,6

How Long Can You Take HRT Safely?

The length of time a patient can supplement hormones can vary by treatment plan and a patient’s condition, medical history and goals.

The study design, however, illustrates that certain factors influence the best treatment plan for each patient. For example, in this 2017 study7, women without a uterus (those that had undergone a hysterectomy) were give estrogen-only therapy, while women with an intact uterus were assigned a combination therapy or estrogen and progesterone. This change improved outcomes for women on hormone therapy for the treatment of menopause. The studies in the 1990s showed that patients with a uterus were at increased risk of endometrial cancer when estrogen-only therapy was prescribed.

Among men who supplement testosterone to address age-related low testosterone and the associated symptoms, the time limit for therapy is not defined and varies by patient.. Men who have prostate issues or have survived prostate cancer need to be especially careful when choosing to supplement testosterone.

Evidence from all studies on hormone replacement therapy suggests that patients should be under the care of a qualified medical practitioner when choosing to pursue hormone therapy. Advanced lab testing and careful review of a patient’s current condition, medical history and lifestyle are essential in determining a treatment plan. The length of treatment may vary. Factors such as age, medical history, dosage and efficacy throughout the course of treatment influence the length of treatment.

Solutions to Symptoms of Hormonal Imbalance

Alternatives to Hormone Therapy

Hormone therapy is not the only solution to hormonal imbalance. Though it is the most effective in many cases, patients may consider alternatives to hormone therapy.

For women seeking medicinal treatment for relief of perimenopause and menopausal symptoms, SSRIs and SNRIs have been found to offer some relief, including addressing hot flashes and mood swings. Sessions with a cognitive behavioral therapist and hypnosis have also been shown to reduce menopausal symptoms.

Behavioral changes can significantly improve symptoms of hormonal imbalance for both men and women, but results will be dependent upon consistent dedication to the established lifestyle changes. Yoga, meditation, weight-bearing exercise, routine cardiovascular exercise, nutritional balance and healthy weight loss and management have all been shown to support successful outcomes.

Choosing the Right Hormone Therapy Program

The key to finding relief from hormonal imbalance is first getting a proper diagnosis through comprehensive lab testing and then seeking treatment from an expert physician who specializes in hormone health and therapy. Although there are a number of clinics and retail outlets that claim to have solutions to hormone balance, few offer comprehensive testing or medical teams that have advanced training and pursue continuing education in hormone health.

When pursuing hormone therapy, you need to do your research and ask questions. Remember hormone replacement therapy is not one-size-fits-all. To help guide you, here are questions to ask before beginning any treatment plan:

  1. Do the potential benefits outweigh the potential risks?
  2. Is this the right choice for treatment?
  3. Are there better or safer options?
  4. What is the side effect profile?
  5. Will HRT completely resolve the symptoms?

You should carefully evaluate your options and understand all the possibilities for treatment—this information will help you make the most educated decision. Talk to your doctor, get a few opinions as you assess your treatment options. Seek expertise, advanced training and comprehensive care throughout your journey.

Safe and Effective Treatment for Hormonal Imbalance

The practitioners of the BodyLogicMD network are experts in hormonal health and balance. Each physician is required to complete rigorous requirements in medical education and maintain minimum continuing education in the field. Every doctor begins the patient journey with comprehensive lab testing, including analysis of saliva, urine and blood to support the diagnosis and treatment of your hormonal imbalance. In addition to review of your lab results, your physician will sit down with you for a one on one consultation to discuss your symptoms, medical history and lifestyle—factors that influence treatment and outcomes.

Bioidentical hormone therapy is only part of the solution when seeking to achieve hormonal balance and enhance your wellbeing. The physicians of the BodylogicMD network understand that the road to optimal health and true balance includes guiding you through other principles of wellness, including recommendations for routine fitness, balanced nutrition and stress management. All treatment plans are tailored to you. You have a lifestyle, medical history and health goals that are all your own, therefore you need a treatment plan that is very specific to you. Not to mention that as your treatment progresses, your goals may evolve—the physicians of the BodyLogicMD network are there to support you every step of the way.

If you believe you are suffering from a hormonal imbalance, contact the team at BodyLogicMD. Ask questions, get answers and take the first step to feeling your very best once again. Contact a practitioner of the BodyLogicMD network nearest you.