Hormone therapy is it safe and right for you?

Stanford's Dr. Karen Adams has some rather reassuring things to say about HRT.

First, a bit of history. Back in 2002, a massive study called the Women's Health Initiative absolutely terrified everyone about hormone therapy. They stopped the trial early because of increased risks of breast cancer, blood clots, and heart disease. Suddenly, hormone therapy went from being the bee's knees to being treated like something you'd find under a rock. An entire generation of women (now 65-80) missed out because doctors stopped prescribing it and medical schools stopped teaching it.

But here's the plot twist: the 20-year follow-up data published in 2024 showed no increase in deaths from breast cancer or heart disease. In fact, women who started hormone therapy under 60 had lower overall death rates. The breast cancer risk? Eight cases per 10,000 women per year – obesity, sitting around all day, and having a glass of wine pose bigger risks.

The key is getting the timing and delivery right. Start within 10 years of your last period (there's a "window of opportunity"), and definitely don't take estrogen pills because they make your liver produce clotting factors. Patches or gels deliver estrogen directly into your bloodstream, bypassing the liver and reducing the clotting risk to normal levels.

Dr. Adams also champions bioidentical hormones – ones your body actually recognises – rather than the synthetic versions used in the original study. These are less inflammatory, which is always a good thing when you're trying to age gracefully.

The benefits are rather impressive: hot flushes and night sweats disappear in 3-4 weeks, your vagina becomes more comfortable (important for obvious reasons), brain fog lifts, sleep improves, and you get long-term bone protection. There's even something called "menopausal zest" waiting for you on the other side – apparently, most women end up happier than they've ever been once they navigate these choppy waters.

Of course, it's not for everyone. If you've had hormone-sensitive cancer, blood clots, heart attacks, or certain liver conditions, it's off the table. But for many women under 60 who are struggling with symptoms, it's worth a conversation with a knowledgeable doctor.

Just a friendly reminder: I'm sharing what I've learned, not prescribing what you should do. Always chat with your GP about what's right for your unique situation!

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