Menopause Hormone Therapy gets Graded a D for Prevention of Disease from the USPSTF. Let's take a closer look.
I’ve seen a lot of concerning comments and private messages on Instagram about why some people are taking menopausal hormone therapy (MHT). Apparently, there are providers promoting menopause as a disease and estrogen as not only a cure, but a literal fountain of youth. It’s disturbing to see this Big Pharma marketing from the 1960s making a comeback. The issues here are two fold. Some people are being misled about the benefits of MHT, meaning they are taking it thinking they are protecting their health when they are not. the other concern is that this messaging leads some people who aren’t taking MHT to feel as if they are missing out, and even worry.
There is a lot of hormone disinformation when it comes to menopause. Basically, menopause has become a big business for some. I’ve written about the dangers of pellets before, and you can read them here. Every menopause guideline recommends against them. There is no safe way to take them and if your provider assures you that they are safe for your because you are getting your hormone levels monitored, you have been misled or lied to depending on their intent. Pellets are actually on my list of “How you know you are getting bad medical advice.” If your provider advertises pellets or recommends them, get up and walk out the door and get another provider. For everything. If they think pellets are worthy, what else don’t they know?
But what about standard pharmaceutical menopause hormones? Such as transdermal estradiol (think patch, spray, gel etc) or oral estrogen (there are a couple of different ones). Those are okay, right? Well, like any medication, in the right circumstances they are safe (meaning benefits outweigh risks). And like every medication, you shouldn’t be taking it if you don’t need it or if it can’t do what you want it to do (meaning no benefit, all risks).
Menopause hormone therapy is being recommended by some providers to prevent almost every health condition that you can think of, the most common that people hear are the following:
Preserve muscle mass
According to these providers THE ONLY WAY TO LIVE A LONG, HEALTHY LIFE IS VIA HORMONES HORMONES HORMONES.
This is in all caps because I swear they feel like used care salespeople. And interestingly, a large percentage of them are in private practice (both in the US and UK), underscoring the financial benefit of this approach.
This idea of taking MHT to prevent a disease that you don’t have is known as primary prevention. It was one of the main ideas behind the Women’s Health Initiative (WHI), which looked at estrogen preventing cardiac. And this week the US Preventive Services Task Force (USPSTF) published their latest review of the evidence, so let’s take a look. It applies to people starting estrogen or an estrogen plus a progestin at age 45 or older and specifically looks at MHT for the prevention of common chronic diseases, like osteoporosis and fractures, dementia, and cardiovascular disease. This isn’t a guidelines for MHT for symptoms, such as hot flashes and night sweats, although sometimes people are persuaded to take hormones for these reasons because they are incorrectly told that hormones will also prevent chronic conditions.
Here are some nice visuals from the article that encapsulates what the USPSTF was looking for, basically, what is the evidence that menopausal hormone therapy causes or prevents these conditions?
The next chart immediately below summarizes the results of the USPTF review for estrogen plus a progestin (progesterone or a progestin), and the one for estrogen alone is below that.