Hormone replacement therapy: What doctors want women to know about HRT

A woman’s estrogen levels are a delicate ever-changing balance. Hormone replacement therapy (HRT) is a part of medicine that hasn’t received much attention until recently. So much is changing in terms of who should seek hormone replacement therapy and how much it can benefit women.

In 2002, the results of the Women’s Health initiative caused a massive drop in HRT use because findings showed a link to breast cancer.

“We’ve been taught that estrogen induces a cancer when, in reality, it doesn’t,” said Dr. Elena Rodriguez, a board certified gynecologist.

She said after decades of more study, the FDA lifted its black box warning. But still, many patients and doctors are slow to recommend HRT to women.

“There needs to be a movement to try to make this more known to internal medicine, family medicine. We owe it to our female patients to be able to understand it,” she said.

Estrogen plays a role in every system of a woman’s body from reproduction, to the heart, bones and brain. In her practice, Rodriguez is seeing many patients dealing with hormonal changes starting at a younger age.

“I’m certainly seeing it a lot more in our 40-year-olds,” said Rodriguez.

Estrogen levels can be tested in blood, urine and saliva. Because estrogen levels change so often, multiple tests may be needed to detect a problem.

“Right as our period ends, our estrogen levels are very low. And then as we peak during ovulation, you’re going to see a very high level,” she said.

Then, it drops again. Doctors say if a woman’s estrogen fluctuates incorrectly or just stays at a high level, that can cause big issues.

“That can lead to problems with the menstrual cycles and abnormally heavy bleeding. You can increase your risk of certain cancers, particularly uterine cancer,” said Dr. Rita Ellen Eye.

The goal of estrogen therapy is to correct that imbalance.

Abnormal fluctuations can start in your 30s, but for post menopausal women who’ve never taken hormone therapy, Rodriguez says it’s never too late.

“It’s pretty equal in terms of the patients that are seeking care,” she said.