Hormone replacement therapy (HRT) involves taking estrogen, progesterone, or testosterone to replace hormones that decline naturally with age. HRT can provide relief from menopausal symptoms and protect long-term health in some people. However, HRT also carries risks that need to be weighed against potential benefits on an individual basis. Not everyone is a good candidate for hormone therapy.
Some key contraindications for hormone replacement therapy include:
- Breast, uterine, ovarian, or endometrial cancer: Adding extra estrogen can fuel the growth of hormone-sensitive cancers. Survivors of reproductive cancers should avoid HRT.
- Blood clots: Estrogen raises clotting factor levels in the blood. People prone to blood clots, like those with factor V Leiden thrombophilia, are advised to avoid HRT due to increased clot risk.
- Heart disease: HRT does not clearly prevent or promote heart disease on average, but may be harmful in people with a history of heart attack or angina. Consult a doctor about your individual cardiac risk.
- Liver disease: Oral estrogen is processed by the liver and can worsen liver problems. Transdermal patches may be safer for those with liver issues.
- Dementia: HRT initiated after age 65 is linked to a higher dementia risk. The timing of therapy initiation appears crucial.
- Stroke: Studies link oral estrogen to a slight increase in ischemic stroke risk in postmenopausal women. Discuss stroke risk factors with your doctor.
- Vaginal bleeding: Unexplained vaginal bleeding should be evaluated before starting HRT, as it may signal uterine cancer.
- Pregnancy: Hormone therapy is not indicated during pregnancy or breastfeeding.
- Hypertriglyceridemia: Estrogen can raise blood triglycerides. People with very elevated triglycerides may want to correct this prior to HRT.
- Migraines: Estrogen patches may be preferable over pills for migraine sufferers, as estrogen fluctuations can trigger headaches.
In addition, some groups remain understudied regarding hormone therapy safety and benefits. Caution is urged for:
- Transgender patients seeking masculinizing or feminizing HRT. Long-term data is limited and protocols vary. Work with a specialist.
- Non-binary individuals seeking targeted effects. Research is scarce on optimal regimens. A specialized provider is advised.
- People with disabilities who may have difficulties with patch adhesion, injections, or fertility preservation. Reasonable accommodations should be made.
- Racial/ethnic minorities given historical exclusion from clinical trials. Dosing refinement may be needed to maximize safety.
Ultimately, the choice to start or continue hormone replacement therapy is highly individualized. Have an open discussion with your healthcare provider about your symptoms, medical history, and goals for treatment. Be sure to ask about the potential benefits, harms, and alternatives to HRT for your situation. Stay up-to-date on screening tests relevant to your gender, organs, and age. Report any new or concerning symptoms promptly during treatment. You may also consider getting a second opinion from a
menopause specialist or hormone therapy expert like those at
Harmony Hormone Clinic, who offer cutting-edge therapies and customized care through a holistic approach. With the right information and monitoring, hormone therapy can be safe and transformative for many people.
