How long should you stay on HRT

Dr. med. Gabriele Freifrau von Villiez

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Hormone Therapy Yesterday and Today

A summary: Can I still take hormones after the American WHI study has been canceled?

Now that the excitement about hormone replacement therapy has subsided over the past few months, many women are still deeply uncertain about the benefits and risks of their hormone treatment. Many of the inquiries I am currently receiving have the following wording: "I am satisfied and symptom-free with my hormone treatment, but do not know whether I can continue to take the hormones." The frequency of the questions is reason enough to devote oneself to this topic again and to take a critical look at it.

First of all, the most important facts in a nutshell:
HRT (hormone replacement therapy) actually increases the risk of thrombosis by 100 percent! Out of 10,000 women a year with HRT 34 and 16 without HRT will develop a thrombosis. 8 women also suffer a pulmonary embolism every year with HRT. You have long known that the risk of thrombosis increases in smokers. This finding is not new, but it is always impressive. This means that the individual risk of thrombosis should always be critically examined before starting hormone therapy. Perhaps now is the time to quit smoking for good.

Furthermore, HRT increases the risk of heart attack by 29 percent and the risk of suffering a stroke by 41 percent. In relative terms, this is a lot if you look at the absolute numbers, but things look different. Out of 10,000 women a year with HRT 38 and 30 without HRT will have a heart attack. 8 women also suffer a stroke every year with HRT.

The risk of breast cancer increases by 26 percent, which means 8 additional diseases for every 10,000 women. In the case of colon cancer, the picture is reversed: 6 fewer diseases out of 10,000 hormone users. Here the risk is reduced by 37 percent. In addition, hormone therapy is able to reduce the risk of osteoporosis by 34 percent. Five fewer women suffered a hip bone fracture.

So much for the numbers again. When interpreting these numbers, it is important to know that the study was conducted by cardiac specialists, not gynecologists. These heart specialists actually wanted to prove that hormones, taken preventively, protect against a heart attack. They don't do that.

However, this is and has never been a reason to prescribe hormone therapy in Germany. We use hormone therapy to treat severe menopausal symptoms (and for osteoporosis prophylaxis).

I think the bottom line is how are you doing and how are you feeling? If the hormones are playing tricks on you again and the menopausal symptoms have a lasting effect on your love of life and quality of life, the use of hormone therapy is definitely justified.

This means: Before you decide for or against hormone treatment together with your gynecologist, you should draw up an individual "risk-benefit balance": What will hormone treatment bring me and what are my personal risk factors.

Hormones are a potent and differentiated therapeutic agent, the use of which needs to be carefully considered. Therapy must be tailored to your personal needs. So you should definitely not share the little pills with your good friend, as "the pill" used to be exchanged or borrowed. Furthermore, what has been true of the pill since yesterday applies to hormone replacement therapy: as much as necessary, as little as possible. The trend is clearly towards low-dose preparations that only contain 1 mg of estradiol. It also makes perfect sense to start with an individually dosed preparation that is as low as possible and only switch to a stronger preparation if necessary.

Another important question is how long should hormone therapy be continued? Simple answer: as long as it takes! The risk of breast cancer, which every woman is most afraid of, only increases after a period of 5 years. This is a good time to question hormone therapy again. Do I really still need the hormones?

However, you shouldn't make the mistake of stopping your hormone treatment overnight. Because then there is a good chance that menopausal symptoms will reappear, regardless of age. It is cheaper to "taper off" hormone therapy, i.e. you halve your tablets or only take one tablet every other day for a period of approx. 3 months. Then try to stop taking the hormones. If you notice on the way that you are again suffering from severe symptoms, you can start taking the tablets again at any time. It should therefore be expressly pointed out here that if the benefits of such a treatment predominate, the continuation can be entirely justified. Then, a few years later, you could try the next vent. The important thing here is to consciously make a decision and not continue something because it has always been that way.

I think that is what hormone therapy is about, as it is with many other questions and decisions in life: Find out more and then make conscious choices, depending on your personal wishes and needs. It's about you.

I wish you all the best.

Dr. med. Gabriele von Villiez