Hormone Replacement Therapy: Debunking Common HRT Myths

Hot flashes, night sweats, mood swings: menopause is an inevitable milestone in a woman’s life and can often feel like a rollercoaster. Dealing with these symptoms can have a lasting impact on quality of life and personal relationships. That’s why it’s our personal mission at Frazine Wellness to empower women with the knowledge and understanding needed to make informed decisions about their health and well-being during this transformative phase of life. 

At Frazine Wellness, we offer hormone replacement therapy consultations, designed to provide you with the dedicated time and expert care you need to navigate menopause and explore treatment options. 

Meet the Team

We are proud to have Deborah French, PA-C, CSC, leading this initiative. With over 21 years of experience as a physician assistant and an extensive background in women’s health and hormone replacement therapy, Deborah brings a wealth of knowledge and compassion to her practice. Her passion lies in enhancing the health and well-being of perimenopausal and menopausal women, addressing the often-overlooked need for comprehensive care during this pivotal stage of life. Deborah is committed to optimizing the mental, physical, and sexual well-being of her patients, ensuring they feel their best. 

Deborah holds a postgraduate certificate in Sexual Health from the University of Michigan and is an AASECT certified sexuality counselor (American Association of Sexuality Educators, Counselors, and Therapists). She is also in the process of becoming a NAMS (North American Menopause Society) certified menopause provider. With her specialized training and dedication, Deborah aims to dispel the myths surrounding hormone replacement therapy and provide her patients with accurate, up-to-date information. 

Schedule a consultation with Deborah French today and take the first step towards a healthier, happier life. 

Menopause and Perimenopause

Menopause marks the end of fertile years—it typically occurs in your late 40s early 50s. It’s officially diagnosed when a woman has gone without a menstrual period for 12 consecutive months. Perimenopause is the transition period to menopause that can last up to 10 years. During this time, the ovaries gradually produce fewer hormones, particularly estrogen and progesterone.

This hormonal shift can cause various symptoms including:

• hot flashes
• night sweats 
• mood swings 
• brain fog 
• sleep disturbances 
• vaginal dryness 
• pain with intercourse 
• lower sex drive 
• weight gain 
• increased joint pain 
• changes in skin and hair 

For more information on menopause and perimenopause, visit the North American Menopause Society’s (NAMS) website. Hormone replacement therapy has long been a topic of debate with misinformation surrounding its risks and benefits. In this blog, we’ll debunk some of the common myths associated with HRT in menopause.  

Myth #1: Taking hormone replacement therapy causes breast cancer

The myth that HRT causes breast cancer stems from early studies like the Women’s Health Initiative trial, which suggested an increased risk of breast cancer associated with certain types of hormone therapy. The WHI study used oral conjugated equine estrogen and synthetic progesterone in women long after menopause onset. Participants in the study, on average, were 63 years old.  While later research clarified the importance of the type and timing of hormone therapy, the fear of breast cancer from hormone replacement therapy became so widespread that misinformation is still common 20 years later. As a result, most healthcare providers practicing today received little if any training on menopause or menopause hormone therapy.  

Hormone replacement therapy is best initiated around the time of menopause. For women aged 50 to 59 years in the WHI study, HRT did not increase cancer or cardiovascular deaths after a median of 18 years’ follow-up compared to women not taking hormones. With estrogen alone, breast cancer mortality was reduced. Women taking combined HRT (estrogen+progesterone) had a slightly higher risk of breast cancer, but the risk was still low.  To put it into context, you are more at risk of getting breast cancer in your 50s from lifestyle factors such as being overweight or drinking 2 or more weekly alcoholic beverages than from taking HRT. 

Myth #2: I have a family history of breast cancer, so I am not able to take hormone replacement therapy.

Having a family history of breast cancer does not automatically disqualify someone from receiving hormone replacement therapy. Healthcare providers take an individualized approach to assessing breast cancer risk and determining the appropriateness of hormone replacement therapy. While a family history of breast cancer may increase a person’s overall risk, it does not necessarily mean that HRT is contraindicated. Other factors, such as personal medical history, age, menopausal symptoms, and lifestyle factors, are also considered. 

Myth #3: Menopause is a normal, natural event. It does not need any treatment.

You may be tempted to tough it out and suffer through the inconveniences caused by the hormonal changes of menopause. However, symptoms such as hot flashes, night sweats, mood swings, and sleep disturbances can significantly impact a woman’s quality of life. These symptoms can interfere with daily activities, disrupt sleep, affect mood, and strain relationships. Suffering through these symptoms unnecessarily can have a detrimental effect on a woman’s overall well-being and happiness. The best action you can take is to arm yourself with accurate information about menopause and hormone replacement therapy.

Here are two resources that can be helpful to understand the facts about menopause and research on hormone therapy: 

• Estrogen Matters
• The Menopause Manifesto

Ultimately, the decision of whether to use hormone replacement therapy to manage menopausal symptoms should be based on an informed discussion between a woman and her healthcare provider. It’s an individualized approach– weighing the potential benefits and risks in the context of an individual health profile and preferences. Regular monitoring and follow-up with a healthcare provider are important for assessing the ongoing need for hormone replacement therapy and managing any potential risks or side effects. 

Myth #4: Hormone replacement therapy is only used to treat menopause symptoms.

While HRT is often prescribed to manage menopausal symptoms such as hot flashes, night sweats, and vaginal dryness, its benefits extend beyond symptom relief. HRT can help prevent bone loss and reduce the risk of fractures associated with osteoporosis, particularly in women at higher risk. Additionally, some women may choose to use hormone replacement therapy for other reasons, such as reducing the risk of heart disease, improving sleep, improving mood, improving cognitive function, or overall well-being. 

Myth #5: Bioidentical hormones that are compounded are the safest and best option.

Custom-compounded hormones are not safer or more effective than FDA-approved bioidentical hormones. They are not tested for safety and effectiveness or under FDA regulations to prove that the active ingredients are absorbed appropriately or provide predictable levels in blood and tissue. Therefore, having unpredictable hormones levels can be risky especially for women who still have an intact uterus. For example, if a woman is on a form of progesterone that has not been studied on how well it is absorbed, the progesterone level can be too low and increase her risk for endometrial (uterine) cancer. The term “bioidentical hormone therapy” began as a marketing term for custom-compounded hormones. Bioidentical hormones do not have to be custom-compounded to have the same chemical and molecular structure as hormones produced in the body. There are many well-tested, FDA-approved hormone therapy products that meet this definition and are commercially available from retail pharmacies in a variety of doses that will allow you and your healthcare provider to customize your therapy to meet your needs.  

Myth #6: You must wait until your periods have stopped before taking hormone replacement therapy.

You can start taking HRT as soon as you begin experiencing bothersome symptoms, even if you’re still having periods. The perimenopausal phase can last up to 10 years for some women. Treatment decisions should be based on individual factors, and starting hormone therapy earlier in the menopausal transition may provide significant benefits in terms of symptom relief, bone health, and overall well-being.  

Myth #7: You can only take hormone replacement therapy for five years. 

Hormone replacement therapy can be taken as long as the benefits outweigh the risks.  The North American Menopause Society (NAMS) and the American College of Obstetricians and Gynecologists (ACOG) emphasize the importance of individualized treatment decisions based on a thorough evaluation of each woman’s unique circumstances. These guidelines recognize that there is no arbitrary time limit on the duration of hormone therapy and that treatment decisions should be based on careful consideration of the individual’s risks and benefits.  

Myth #8: Hormone replacement therapy causes weight gain. 

While some women may experience bloating or fluid retention initially, studies have not consistently shown a significant association between HRT and long-term weight gain. The main contributors to weight gain during menopause are declining estrogen levels, age-related muscle loss and lifestyle factors.  Hormone replacement therapy can help alleviate symptoms like hot flashes, insomnia, and mood swings, which might indirectly contribute to menopausal weight gain. 

Myth #9: After menopause, your sex life is over.

The notion that your sex life is over after menopause is a myth. While menopause may bring about changes in sexual health and function, it is certainly not the end of the road for intimacy and pleasure.  Menopause causes hormonal shifts that can affect sexual desire, lubrication, and arousal.  However, with the right support, communication, and management strategies, many women continue to experience satisfying and fulfilling sexual encounters well beyond menopause. 

There’s a myriad of treatment options available to address common menopausal symptoms that may impact sexual health. HRT stands as a cornerstone, offering relief from symptoms like vaginal dryness and discomfort, thus enhancing overall sexual function. Moreover, medications such as Addyi and Vyleesi have emerged to address diminished sexual desire, providing additional avenues for improving intimacy.  The International Society for the Study of Women’s Sexual Health (ISSWSH) has laid out recommendations for testosterone therapy in women experiencing low sexual desire or hypoactive sexual desire disorder (HSDD).  Additionally, non-hormonal treatments, including lubricants and moisturizers can also provide relief and enhance sexual comfort and pleasure. 

Myth #10: Testosterone is a “male” hormone. 

Many people who think of testosterone as a “male” hormone are surprised to find that women normally produce 3-4 times more testosterone than estrogen prior to menopause. Testosterone is linked to sexual desire and arousal, but also to mood, energy level, and general wellbeing. It also works with estrogen to maintain bone and muscle mass.  Testosterone levels decrease over a woman’s lifespan. Despite its importance, testosterone deficiency in women has received very little research attention and few products address female testosterone replacement. In all countries (other than Australia), there are no licensed testosterone products available for women. Research on testosterone therapy in women is limited but shows promise in improving sexual function and urinary tract health, as well as benefiting bone density, muscle mass, mood, energy, and cognitive function. 

Schedule a Consultation

At Frazine Wellness in Paducah, Kentucky, our providers will customize a treatment plan to specifically target your symptoms and concerns. This starts with an in-depth consultation with Debbie French, PA-C. During the consultation, you will discuss your concerns and symptoms. You will receive a treatment and follow up plan. If hormone replacement therapy is decided is a suitable treatment, you’ll use your medication as prescribed in a home setting. From there, your provider will evaluate your treatment in a follow up visit. Your treatment plan will be adjusted if needed, since one size does not fit all. Once we have determined your best treatment plan, follow up visits will be every 6 months. Additional information regarding pricing and FAQ can be found here.  

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