Key Takeaways
Lab testing doesn't guide HRT treatment decisions
Dr. Green explained that hormone levels fluctuate on an hourly basis, making lab testing an unreliable guide for HRT treatment decisions. Both the ACOG and Menopause Society recommend against routine labs for guiding menopause hormone therapy. He emphasized that patient-reported symptoms serve as the most reliable means of determining treatment candidacy and tracking progress.
Combined HRT carries benefits and risks individualized to each patient
Many women worry that HRT will cause cancer. Dr. Green noted that while combined estrogen-progesterone HRT carries a small increase in breast cancer risk, it also lowers the risk of colon and uterine cancer. He also highlighted its cardiovascular benefits as part of the whole clinical picture, noting that heart disease remains the leading cause of death for women overall regardless of whether or not they use HRT. He encouraged women to evaluate their concerns holistically when weighing the benefits and risks of individualized treatment.
It's progesterone, not estrogen, behind the small cancer risk increase
Counter to what many patients might assume, Dr. Green pointed out that research indicates the small increased risk of breast cancer associated with combined HRT comes from progesterone, not estrogen.
IUDs don't automatically replace the need for progesterone
Dr. Green explained that while a progesterone-releasing IUD can protect the uterine lining, he prefers prescribing supplemental progesterone alongside systemic estrogen to ensure continued endometrial protection in the event that the IUD becomes displaced or expires.
Starting HRT more than 10 years post-menopause isn't recommended
Dr. Green noted that for women more than 10 years past natural or surgical menopause, beginning HRT for the first time carries more risk than benefit. He added that other non-hormonal options can still help with symptoms like hair thinning or hot flashes.
