Related Topics: Heart Disease, HRT

Why 5 Years Is The Maximum Recommended Time For HRT

Guidelines on long term HRT use confirm increased health risks particularly for cancer, heart attack and strokes. Bioidentical hormones have no such risk and are effective for menopausal symptoms.

AnnA Rushton

The recommendations regarding hormone replacement therapy (HRT) for menopause have gone through a very confusing transition over the past decade. Those recommendations have changed from strongly encouraging HRT, to strongly discouraging it, to now somewhere in between.

The current thinking on HRT

Most women on HRT take both oestrogen and a synthetic progestin/progestogen. The progestin is added because oestrogen alone causes the lining of the uterus to grow excessively, thus increasing the risk of uterine cancer.

Adding progestin reduces the excess risk of uterine cancer, but a better protection is bioidentical natural progesterone which sadly does not occur unless women supplement separately.  Currently in women who have had their uterus removed HRT will consist of oestrogen alone which gives rise to oestrogen dominance symptoms, again which can be alleviated with bioidentical natural progesterone.

Originally it was thought that HRT would protect women from heart disease. This assumption followed from two observations. First, the incidence of coronary artery disease  in women rises substantially after oestrogen levels fall during menopause. Second, using HRT in menopausal women causes a favorable change in cholesterol levels and in other cardiac risk factors.

So, doctors thought, the drop in oestrogen which accompanies menopause was contributing to the development of CAD in older women; replacing oestrogen (with HRT) should help to prevent CAD. And for many years HRT was widely recommended and used in menopausal women.

But then, early in the last decade, this was greatly disrupted by data from the Women’s Health Initiative (WHI) study which showed that women who received HRT with oestrogen and progestin actually had a significantly higher risk of heart attacks and strokes, as well as an increase in blood clots and breast cancer. Women who were able to receive estrogen-only HRT  did not have an increase in heart attacks or breast cancer, but had an increase in strokes and blood clots.

Why Does HRT Have To Be Temporary?

HRT should be avoided in any woman who has had breast cancer, CAD, heart attack, stroke, or blood clots. The hormones used in HRT increase the risk of breast cancer.

It looks like it takes about 10 years of therapy with oestrogen alone to produce an increase in breast cancer, but only five years or so for the combination of estrogen and progestin to bump up the risk of breast cancer.

So virtually all experts recommend that, if HRT is to be used, it should be used for less than five years.

Helpful information:


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AnnA Rushton | 1:01 pm, June 14th, 2014

We would be delighted to see large scale studies of bioidentical hormones done Diana , but so far this is not happening anywhere in the UK or US that we are aware of, and we do advocate the use of only bioidentical hormones for HRT replacement/hormone balance and not the use of synthetic hormones.

Diana | 5:22 pm, June 12th, 2014

Can’t edit here, but my prior comment should have said, “…The studies that current recommendations are based on evaluated the use of a synthetic …”.

Diana | 5:19 pm, June 12th, 2014

More dissemination of misinformation and flawed analysis. The studies current recommendations are based on the use of a synthetic progestin, and often a synthetic estrogen as well. It is a whole different ball game when using bioidentical progesterone and bioidentical estradiol. More large-scale studies are needed to show a complete picture, but there is some evidence that suggests bioidentical hormone replacement may actually reduce the incidence of cardiovascular disease, stroke, cancer, and osteoporosis far beyond 10 years. Very surprised to see this crucial distinction ignored and/or unrecognized – particularly on a blog entitled “Bioidentical Hormone Health,” which sadly just underscores just how poorly the basics of bioidentical hormones are understood.

AnnA Rushton | 10:21 am, January 13th, 2014

Many women who are breast cancer survivors, or undergoing treatment use bioidentical progesterone safely as the following article by Dr Ray Zava shows. The only caution is that NO hormone cream should be applied to the chest or breast area, whether you are a cancer risk or not.

AnnA Rushton | 9:56 am, January 12th, 2014

Oral progesterone is usually a much higher dose as much is lost when it is processed by the liver, but transdermal creams go straight into the bloodstream so much less is needed.

jr | 11:48 pm, January 9th, 2014

Thank you. She spoke with her oncologist who said he saw no problem with oral micronized progesterone for symptom relief as she is 18 years out of the woods. Funny thing is that the transdermal creams aren’t good for sleep but the pills are. He was very adamant though that she avoid any estrogen, bioidentical or otherwise, as its risks are too high, especially in women over 65.

AnnA Rushton | 2:37 pm, December 27th, 2013

We know that transdermal progesterone is safe for breast cancer survivors as it is in a low dose and has been used by women who are on chemotherapy and tamoxifen. We cannot comment on the much higher dose or oral progesterone as that is used differently by the body as it is processed by the liver and is a much higher dose. This article by Dr Ray Peat may be helpful:

jr | 6:44 am, December 24th, 2013

Here’s a question?? My mom is a 67 year old, 18 year breast cancer survivor who took tamoxifen for 5 years. She continues to have hot flashes and sleep problems, including shallow breathing. She ordered micronized progesterone (200 mg) capsules online and has been on it a week.

Is this safe to do? My objective self says yes, given that progesterone is actually a neurosteroid primarily and critical for brain health. I know the hormone does not cause clots or high blood pressure. The only thing I worry about is the breast cancer. And I am aware of the cellular/animal studies and the E3N all showing that estrogen + progesterone has a different effect on breast cells than progestins. Still, is this a risky decision in a cancer survivor?

AnnA Rushton | 8:51 am, November 12th, 2013

No Josephine you can use bioidentical hormones all your life for osteoporosis and as long as you have symptoms for other conditions, as there are no withdrawal or side effects

Josephine Kessels | 2:51 pm, October 24th, 2013

Only 5 years HRT; is this also the advice for natural hormones?

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