By: Dr. Elizabeth Braley, PT, DPT, OCS, CSCS
First, let's talk about estrogen. Everyone has estrogen, it's not just for ladies. The amount of estrogen present in the body depends on age. Surprisingly men and women who are menstruating have similar levels of estrogen (Reed & Carr, 2015). However, after menopause men have more estrogen than women (Vermeulen et al., 2002).
Hormone Replacement Therapy (HRT) started back in the 1960s and became popular in the 1990s. However, clinical trials did not begin until late in the 1990s. Unfortunately, in 2002 initial study reports related to breast and endometrial cancer risks were published. HRT received a lot of bad press resulting in media hysteria and many individuals terminated HRT. Other early research demonstrated positive effects of HRT on osteoporosis and colorectal cancer, but benefits were not the focus of the media.
More recent research suggests HRT can help prevent osteoporosis, deceased cardiac risks and improve long-term health. Estrogen supplementation alone was associated with a decreased risk of breast, lung and colorectal cancers, heart attack, congestive heart failure, atrial fibrillation and dementia. There was an increased risk using a combination of estrogen and progestogen for breast cancer, but risks were decreased by using topical estrogen (Baik et al., 2024). Topical estrogen creams, like all medications, contain a lot of warnings, however low dose topical (vaginal) estrogen is not linked to significant increased risk for cancer. It is recommended cancer survivors discuss their specific risk with their oncologist. Some of the most common complaints I hear as a pelvic floor physical therapist are often helped by topical estrogen. Topical estrogen can help with symptoms of vaginal dryness, vaginal atrophy, pain with penetration activities and pelvic floor weakness associated with leakage of urine.
A critique of some HRT studies is that the HRT was started 10+ years after menopause. Menopause is recognized as 12 months without a period. There is evidence to suggest starting HRT when the first symptom of menopause start would have the greatest effects on bone mineral density. Menopause has a direct result on our bones because there is a strong relationship between estrogen and bone reabsorption. Bone density peaks around age 30. One year before and two years after a woman's last period there is a significant loss in bone mineral density. Hormone replacement therapy is one possible way to maintain (or slow the loss of) bone mineral density. (Cagnacci et al., 2019).
Bottom line is don't let bad press about HRT from 2002 prevent you from considering hormone replacement therapy. Discussing the possible benefits verse risks of HRT with your medical provider may help with menopause, cardiac, bone mineral density and pelvic floor concerns.
Take Care,
Elizabeth
References:
Baik SH, Baye F, McDonald CJ. Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses. Menopause.
Cagnacci A, Venier M. The Controversial History of Hormone Replacement Therapy. Medicina (Kaunas). 2019 Sep 18;55(9):602. doi: 10.3390/medicina55090602. PMID: 31540401; PMCID: PMC6780820.
Reed, B. G., & Carr, B. R. (2015). The normal menstrual cycle and the control of ovulation.
Vermeulen, A., Kaufman, J. M., Goemaere, S., & van Pottelberg, I. (2002). Estradiol in elderly men. The aging male : the official journal of the International Society for the Study of the Aging Male, 5(2), 98–102.
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