Evidence on hormone therapy is confusing for docs and patients alike. The research is so convoluted it’s difficult to interpret and translate into safe to-dos unless you know the large terrain of the data. And is enough to put anyone into early cognitive decline. So to keep your head and facts clear, read on.

Part of the issue is that headlines that emphasize scary results are made more public while positive results studies don’t garnish as much attention and are often lost to the public and even doctors.
A perfect example of this confusion surrounding presentation of research on hormone therapy comes within one study. Evidence was published in the Cochrane Library by the Department of Cardiovascular Medicine at the University of Oxford in March 2015. The Oxford authors looked at studies on 40,00 women around the world. They concluded that hormone replacement therapy (HRT) did not protect post-menopausal women against heart disease, and may even cause an increased risk of stroke.

This sounded clear cut. Uh oh, HRT isn’t so good for our hearts.

That study and its doom and gloom conclusions made headline news and made women throw their scripts out their windows and docs tell you that you should just eat more greens and get off the couch.

But when the same authors re-analyzed the data, and looked at “younger women” (starting hormone therapy within 10 years of menopause), the results were the opposite! These women had almost half the risk of heart disease.

This bit of data did not make headline news.

They found that women who started treatment within the first 10 years of their menopause, had less heart disease and “no increased risk of stroke”. (But even in this group, the risk of deep vein thrombosis—DVTs or blood clots in the legs—increased.

But yet another caveat. Most of these women were on synthetic progestins and/or oral pills, which are both, linked to a higher risk of clots, while taking hormones on the skin or in the vagina, is not linked to any higher risk of clots at all.

Dr Boardman, the lead author of this study said. “When we looked at the results according to the age of women, or by how long since their menopause that they started treatment, we found that if 1000 women under 60 years old started hormone therapy we would expect six fewer deaths, eight fewer cases of heart disease, and five extra blood clots over about seven years, compared to 1000 similar women who did not start hormone therapy.”

Yet most women and their docs heard that HRT is not good for hearts.

And, most docs don’t know that there are ways to give HRT to older women to slow down the risks and enhance the benefits so that they also should not throw out the hormonal baby with the hormonal bath water.

And, HRT and the brain.

We are all worried, understandably, about out living our wits.

A JAMA study, the Utah Cache County Study showed that women on HRT for 10 years had 50% less—half the risk—of getting dementia. This is huge!
If Dr. Oz said there was something that we could take that would half the risk of losing our cognition as we age, we would RUN out and get it. Again, this did not make any headline news. This study was ‘lost’ to public attention as it came out the same year as the ill-fated Women’s Health Initiative that got docs and women to throw hormones out the window.

What is an aging woman wanting to age more slowly, gracefully and safely supposed to do?
1. Get tested for your unique hormonal footprint soon after you start menopause.
2. Work with a doc in the know, or a team that includes a nutritionist.
3. Hormones lean on nutrients that lean on digestion so if you tried HRT and it didn’t work for you, those other levels may have need to be addressed.
4. Most docs have no idea about this nutritional endocrinology
5. Most docs have not been prescribing hormones for the last 10 years and are somewhat out of the detailed loop and are as confused about hormones as you are so you are apt to get wrong answers when you ask right questions.
6. Go to folks who have been doing this for a long time and know what they are doing.
7. Do not go to a hormone “mill”.
8. Get my easy to read up-to-date book that explains all this Safe Hormones, Smart Women.

And there you have it.

Cochrane Database Syst Rev. 2015 Mar 10;3:CD002229. doi: 10.1002/14651858.CD002229.pub4.Hormone therapy for preventing cardiovascular disease in post-menopausal women.
Boardman HM1, Hartley L, Eisinga A, Main C, Roqué i Figuls M, Bonfill Cosp X, Gabriel Sanchez R, Knight B

JAMA. 2002 Nov 6;288(17):2123-9.Hormone replacement therapy and incidence of Alzheimer disease in older women: the Cache County Study.
Zandi PP1, Carlson MC, Plassman BL, Welsh-Bohmer KA, Mayer LS, Steffens DC, Breitner JC; Cache County Memory Study Investigators.