The mainstream may change its mind on HRT — but I won’t

Medicine has long wrestled with the question of risk versus benefit where hormone replacement therapy (HRT) is concerned. And with such high stakes — including increased risks of lethal conditions like stroke and breast cancer — it’s no wonder why.

I’ve weighed in on this issue more than once — always firmly on the side of bioidentical hormone therapy. In my 25 years of prescribing bioidentical HRT, I have not seen a single instance of it promoting cancer development in my patients.

I mention this so that you’ll keep it in mind as I share the latest “game-changing” news about hormone replacement. Because as usual, the story isn’t as straightforward as the headlines suggest.

In case you missed them, here’s what they said: After nearly two decades of follow-up on participants of the Women’s Health Initiative (WHI) trials, researchers have found that HRT doesn’t raise risk of all-cause mortality — or risk of death from cardiovascular causes or cancer, either.

The combined trials followed more than 27,000 women, all randomly assigned to receive conventional forms of HRT (the ones made from horse urine that caused all the controversy years ago) or a placebo — for anywhere between roughly five and seven years.

Results showed that all-cause mortality was almost exactly the same across all groups. It was the same story with cardiovascular and total cancer mortality — with differences in risk a mere fraction of a percent between HRT and placebo groups.

The conclusion: For menopausal women seeking relief from hot flashes and insomnia, HRT is back on the table as a viable treatment option.

This marks a major departure from recent years, where even many mainstream docs have hesitated to write prescriptions for HRT. And it’s big news for that reason alone, no doubt about it. But does it really change anything?

Not as far as I’m concerned… and here’s why.

On conventional HRT, your risk of cancer or a stroke still goes up — even if the overall effect on mortality stays neutral. And, in fact, when looking at mortality rates specific to breast cancer, the group given a combined estrogen and progestin form of HRT did actually face a higher risk compared to placebo—while the estrogen-only HRT group showed a lower risk.

So especially if you’re at high risk of breast cancer or blood clots, conventional HRT still poses a significant danger to you — even if it reduces your risk of other lethal conditions like hip fracture and endometrial cancer.

Frankly, I fail to see how this is good news for women at all. Needless to say, no one wants to contend with breast cancer or a stroke, lethal or otherwise. And yet, in the case of conventional HRT, that’s exactly what you’re up against — something all the recent celebratory headlines about this study conveniently left out.

You shouldn’t have to risk disfigurement and disability just to get a break from hot flashes and a decent night’s sleep. And if the best thing you can say about a treatment’s potential side effects is that it won’t kill you, well… maybe it’s time to start looking for a different treatment.

Luckily for everyone, a safe and effective alternative to conventional HRT already exists — in the form of natural, bio-identical hormone replacement. And it remains the only kind of HRT I will ever recommend.