If you have a uterus, chances are, you’re going to hit menopause sometime around the age of 50. (And if you love someone with a uterus, you’ll definitely see it happen.)
Menopause is a hormone-filled – or rather, hormone-lacking – time in a woman’s life that leads to famous symptoms like hot flashes and night sweats. (New research indicates that declining hormones may lead to sleep apnea, too.)
For decades, one of the primary treatments for menopause was hormone therapy. While that changed around 2002, modern evidence suggests that hormone therapy might be safer than previously thought when taken wisely.
Which begs the question: is there a role for hormone therapy beyond menopause – even, perhaps, in the realm of longevity?
What is Hormone Therapy
Hormone therapy (HT), sometimes called hormone replacement therapy (HRT), involves taking sex hormones to combat hormone-related disorders. (In women, the hormone of choice is estrogen. By contrast, men take androgens, or male hormones, such as testosterone.)
One of the most common uses of hormone therapy is to treat menopause-related symptoms in peri- to postmenopausal women. Doctors may also prescribe hormones to slow or prevent bone loss (osteoporosis) or treat estrogen deficiencies.
Types of Hormone Therapies
Doctors may prescribe one of two types of hormone therapy to female patients.
Estrogen therapy, or ET, contains only estrogen and treats the majority of menopause symptoms. However, because estrogen thickens the uterine lining, ET-only therapies may lead to a higher risk of uterine cancers. As such, ET is most common in women who have had their uteruses removed (via hysterectomies).
Estrogen plus progestogen/progesterone therapy, or EPT, contains both estrogen and a secondary progestogen hormone. The second hormone helps protect women with uteruses against the risk of endometrial cancer. That said, it may be associated with a slightly higher risk of breast cancer.
Hormone Delivery Methods
Doctors may also prescribe specific delivery methods to suit a woman’s hormone needs.
Systemic hormone therapy circulates hormones via the bloodstream. Systemic hormones address body-wide symptoms like night sweats, hot flashes, and osteoporosis. Delivery methods can include pills, skin patches, creams and gels, insertable rings, and even sprays.
Localized hormone therapy affects only the area where it’s applied. They minimize the amount of estrogen absorbed by the body and come in cream, insertable ring, or tablet forms. Generally, these low-dose estrogen products are prescribed to treat vaginal and urinary symptoms.
Hormone Therapy and Menopause
To understand why hormone therapy treats menopause, we first need to understand menopause itself.
As women age, their ovaries produce less estrogen and progesterone over time. These hormones are most well-known for preparing the uterus for fertilization and pregnancy. But they also perform several essential systemic functions.
For instance, estrogen helps your body use calcium and staves off osteoporosis and bone weakness. It also ensures you maintain healthy cholesterol levels. And progesterone is implicated in steadying your moods, regulating blood pressure, and improving your sleep cycle and quality.
Knowing that, it’s easy to see how reducing these hormones leads to uncomfortable side effects like: • Hot flashes • Night sweats or chills • Vaginal dryness • Insomnia • Mood swings, irritability, and depression • Dry skin, eyes, and mouth • Constantly needing to pee
But by artificially boosting your hormone levels through daily treatment, you can minimize these impacts and sail into menopause a little smoother. Many women who take hormones enjoy benefits like: • Improved mood and sleep • Fewer or less severe hot flashes and chills • Reduced risk of developing osteoporosis or breaking bones • Decreased tooth loss • Lower risk of developing certain diseases like colon cancer and diabetes • Modest improvement in joint pains and muscle function
Plus, women who begin hormone therapies shortly after entering menopause are less likely to die younger.
Risks of Hormone Therapy
Unfortunately, hormone therapy isn’t a risk-free venture.
To start, it comes with several (often temporary) side effects, including: • Inflammation and fluid retention • Monthly bleeding (if you have a uterus) • Vaginal spotting • Breast tenderness and increased breast density • Mood swings • Headaches or migraines • Skin discoloration or irritation
Aside from these – which, while uncomfortable, generally aren’t life-threatening – hormone therapies are known risk factors for more serious problems, too. While the exact risk level and type depends on your age and the specific hormones you take, HT may increase your risk of: • Cardiovascular diseases and stroke • Blood clots • Breast and endometrial cancers • Gallbladder and gallstone problems
However, the science on these risks isn’t set in stone. In fact, new research (and new understandings of old research) suggest that these risks can be mitigated simply by starting on hormones earlier.
Potential Misunderstandings Lead to New Research
Prior to 2002, around 25% of all women took HT for menopause-related symptoms. Today, that number sits closer to 4% – a drastic drop for such a successful therapy.
So, what happened?
The answer: The Women’s Health Initiative (WHI).
The WHI was a randomized clinical trial that found the hormones of the day led to breast cancer, heart disease, and dementia with no benefits to cardiovascular function. As a result of its findings, women and doctors alike dropped the therapy like a hot potato.
Modern research suggests that that may have been a mistake. In fact, many researchers believe that many of the WHI’s adverse findings result from the fact that the study targeted older populations. (Average patient age: 63.)
But nowadays, it’s believed that starting hormone therapy within 5-7 years of hitting menopause and quitting before age 60 can lead to substantial benefits with far fewer risks. Additionally, by switching from non-bioidentical hormones to bioidentical hormones, patients can avoid the worst risks and improve their long-term health.
Howard Hodis of USC is one such researcher who believes HT has been improperly maligned. His research builds on decades of studies that show women who start HT between ages 35-55 show cardiovascular and dementia benefits, rather than declines.
Not only that, but his 2016 study discovered that women who start hormone therapy within 6 years of menopause see less hardening of the arteries. In turn, this translates to lower heart attack and stroke risk in postmenopausal life.
These results have huge implications for women’s longevity, as around 53% of U.S. women die from cardiovascular disease. And it’s possible that hormone therapy has benefits beyond the estrogen pool, too.
Beyond Menopause: Hormone Therapy and Longevity
Due to the real and presumed risks surrounding hormone therapies, the science on HT and longevity can be murky. But there’s enough to indicate that hormone therapies in both men and women could improve longevity. (And if not that, at least one’s quality of life.)
Hormone Therapy Leads to Longer Lives – Or Does It?
One massive survey-style study that ran from 1981-2003 aimed to answer just that question. Researchers looked at how estrogen therapy (or lack thereof) affected all causes of death in over 8,800 women.
Over 22 years, the study’s authors found that women who did not take estrogen died younger (and sometimes sicker) than their estrogen-taking peers. Additionally, the risk of both death and age-related diseases was lowest among longer-term, lower-dose users.
As such, this was one of the first studies to find that low-dose estrogen could lead to lower mortality in older women, regardless of the specific cause of death.
Hormone Therapy and the Heart
Another study looked at estrogen’s protective effects on cardiovascular health in women who started therapy under 60 years old.
Between 1998 and 2012, the authors found that women who took HRT were 20% less likely to see plaque buildup in the arteries of their hearts. Research suggests that estrogen’s protective effects were due to its ability to fight bad cholesterol and boost blood vessel flexibility. Moreover, HRT was associated with a 30% lower risk of early death.
Hormone Therapy: Not Just for Women?
Due to the often-conflicting outcomes of hormone studies, it’s often difficult to determine whether (or how) hormones fight age-related diseases.
But what we know for certain is that aging in men and women is associated with the loss of sex hormones. And it appears that in many populations, declining sex hormones lead to both hormone- and age-related complications.
Additionally, preliminary research suggests that increasing sex hormones in men, as in women, restores some functions those hormones provided in younger years. For example, older men who take testosterone increase their muscle production and strength.
Meanwhile, men with declining testosterone tend to lose muscle tone and strength, leading to a loss of balance. These men are also at a higher risk of age-related diseases like obesity, COPD, type 2 diabetes, kidney and liver disease, and more.
It’s unclear whether these benefits are largely short-term, with a potential for long-term negative effect on longevity. Therefore, more research is needed to understand the impact of male-focused HRT.
Older studies often suggested that hormone therapy could lead to shortened lifespans. Additionally, many linked HRT to various cancers, including endometrial, breast, and ovarian. While these risks haven’t necessarily disappeared, our understanding of them has changed.
For instance, many of the cardiovascular detriments discovered in the WHI study can be linked to using non-bioidentical hormones. And while HT can increase cancer risk, the actual danger depends on the patient’s age and the type of treatment.
Still, even modern research has found that HT can lead to negative complications in women who: • Take hormones for more than five years • Are over 60 years old • Start 10+ years after the onset of menopause
As such, most doctors agree that hormone therapy is safe in controlled moderation. General guidelines now include starting hormones within 5-7 years of menopause and stopping by age 59 when possible. But most of all, it’s recommended to take the lowest dose possible for the fewest years possible.
Hormone Therapy and Longevity: A Likely No for Many
Despite 20 years of medical progress, it appears that the evidence on hormone therapy remains mixed. (Even for those who need it.) While taking hormones can reduce the risk of death and age-related diseases, HT also increases the risk of certain disorders. As such, those on the hunt for an anti-aging cure, particularly men, may want to look elsewhere for the time being.
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