With hormones

Menopause without hormones

Menopause without hormones

Menopause without hormones


Benefits of Hormone replacement therapy

Most women need hormone replacement which is similar to needing glasses to read.
The major clinical problem is the ‘shoe shop’ syndrome: all shops sell shoes but only those from their shop. Doctors can only help with what they know.

No atrophy

  • of the vagina
  • of breasts
  • less dry eyes

Breast Cancer

  • Estrogens increase growth rate and thus :
    • the diagnosis is made 8 years earlier
    • of a less aggressive cancer with lower mortality
  • Not more breast cancers
    • There are no data demonstrating that estrogens induce breast cancers
    • important is that the interval between the onset and the diagnosis is generally some 20 years
    • accelerated growth means that the incidence of cancer diagnosis will be higher in women taking hormone replacement therapy (odds ratio: 1.25)

Positive brain effects

  • less hot flushes and night sweats.
  • fewer depressions
  • less sexual problems
  • better sleep
  • Positive effect on de cognitive function, e.g. memory
  • Minder kans op Alzheimer

Fewer cancers

  • 50% less bowel cancers
  • 50% less adenocarcinoma of the uterus ; (unless estrogen-only therapy)

Women taking hormones live longer

  • Women with ovaries live longer

Better support tissues

  • no osteoporosis
  • less wrinkles
  • less pelvic floor descent and urinary incontinence,
  • less pain in muscles and joints
  • less thin skin

Positive cardiovascular effects


  • 50% less cardiovascular problems

if HRT is taken from the onset of menopause. After a delay of 5 years, this effect disappears. This should be compared to flowers without water.



  • normal risk is 2/10.000
  • with hormone replacement 3-4/10.000
  • oral contraception 6/10.000


Decision tree

  • I prefer to take HRT because of the advantages
    • What dose? depends if the aim is to replace the natural hormones of to treat little problems only
    • with or without menstruation?
    • For how long ?: there is no medical reason to stop HRT (similar to reading glasses to read). It can be wise after age 85 to decrease breast cancer incidence by slowing down growth.
  • Which hormones should I take: an experienced gynaecologist will guide you through this trial-and-error period (similar to trying on a new dress).
  • Which exams are necessary :
    • not more than usual
    • for the 2 yearly mammography, it is better to stop HRT for a short period in order to decrease breast density.

Why are the perception and the press so negative for HRT

  • An overview is rarely available - most specialists see only their field of interest eg the specialists in osteoporosis, cardiology, oncology etc.
  • The terror of breast cancer.  Since the growth of existing breast cancers is accelerated, more breast cancers will be found in the group of women taking HRT  (OR: 1.25) than in a control group. This often is erroneously translated as more breast cancers.  To judge an odds ratio of 1.25, you have to know that this is less than the effect of obesity.
  • Fear to do something not natural :  Mammals in the wild do not have menopause; menopause occurs only in the zoo, i.e. with adequate food, housing and a veterinarian. This explains the slogan: a woman lives longer than her ovaries, i.e. biologically, we were not programmed to reach that age.
  • Good news is no news: the press will highlight negative news.
  • Hormone replacement therapy requires a solid knowledge of endocrinology.
    • Each woman is different in her specific hormone balance. This can be compared with differences in the colour of hair and eyes.  The same holds true for HRT, which has to create a suitable climate.
    • Variable bio-availability. Resorption and availability of hormones vary at least 4 fold between women. Therefore that the dose of hormone has to be adapted.
    •  standard preparations are suited only for the standard woman
  • A problem of oncologic perception  Women with existing breast cancer are treated after surgery with anti-estrogens in order to slow down growth and increase the tumour-free interval.
  • Doctors with less knowledge of endocrinology, together with prudence, will give
    • As little hormones as possible    which teat little problems such as vaginal dryness
    • Phytohormones with unproven efficacy.
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