Yesterday, Dr. Lara Burrows blogged about the benefits of hormone replacement therapy. As a follow-up, I think we should talk about how long a woman should take hormones once she’s comfortable with the risks and benefits. The number one rule? It’s different for everyone! That sounds like I’m avoiding the question, but let me explain.
First, it depends on how you became menopausal. For example, some women experience the start of menopause if they have a hysterectomy and their ovaries removed before their 40s. Several studies have agreed that if you lose your ovaries before age 45, you are at markedly increased risk of heart disease. Remember, heart disease is the No. 1 killer in women! The North American Menopause Society recommends that women who go through early surgical menopause should take HRT at least until the age of natural menopause, which is at about age 52.
For the rest of us, it really depends on our life situation. At the average age of menopause (52), most women are still working while taking care of their children and also taking care of their parents or in-laws. I call this age the “Sandwich Generation.” They feel pressure on both sides and still have a lot of life stressors. In my experience, most women start on HRT at menopause, and then life gets less stressful around age 60 (closer to retirement, kids getting older, etc.). It’s then that women think about getting off HRT.
There’s a scientific explanation that comes into play. At menopause, the ovary no longer produces estrogen and progesterone, two predominant hormones. Our adrenal gland, a gland that produces many hormones including many important for survival, produces androsteinedione and DHEA. These hormones convert into estrogen and testosterone in our muscle and fat cells, providing us with hormones after menopause. DHEA is depleted with chronic stress. So, if you have a lot of stress, you may need to take your hormones longer than someone who doesn’t.
Sound confusing? Think of it this way: While you are working, you get a monthly paycheck. When you retire, you will live off your savings account. The age you retire determines when you stop depositing in your savings and start withdrawing off of it for expenses. So, if your ovary is your “paycheck,” then your adrenal gland is your “hormone savings bank.” If you have been frugal and saved (good with stress relief, diet, sleep), you will have a good “balance” in your savings account and live comfortably at retirement. However, if you have lived beyond your means (not enough sleep, poor diet) or had unexpected bills your whole life (a sick family member, stress out of your control), then you will need HRT (or social security funds) for longer.
The bottom line is that HRT no longer has the cardiovascular benefit past age 60, and the risk increases with the length of use. At that age, I start assessing my patients’ levels of all other hormones and discuss weaning off HRT.
If you have personal experience with HRT and you feel comfortable sharing, I’d love to hear about it the comments section below.
Tara Scott, M.D.
Certified Menopause Practitioner
Department of OB/GYN
Summa Akron City Hospital
Summa Health System