HRT: A look at the opportunities and risks & the impact of the WHI study

Hormone replacement therapy (HRT) has experienced a rollercoaster of opinions in recent years. From euphoric enthusiasm in the 1990s to complete demonization after the WHI study in 2002 - HRT was and remains a controversial topic.

Today, thanks to new research and a more differentiated approach, HRT is once again being viewed in a more favourable light, especially bioidentical hormone therapy. It can be an effective and safe option for many women to alleviate the symptoms of menopause, provided it is properly supervised!

"Peri- and postmenopause Due to the WHI study of 2002, the administration of sex hormones to treat complaints during and after menopause has fallen into disrepute. However, the current data makes hormone replacement therapy appear in a much more favorable light. It is even conceivable that a preventive aspect will play a role in its evaluation in the future."
Quote from Dr. Katrin Schaudig, Dr. Anneliese Schwenkhagen(1)

The GHI Study: A Turning Point

The 2002 WHI (Women's Health Initiative) study led to a dramatic change in opinion regarding HRT. It was the largest prospective randomized placebo-controlled study ever conducted on hormone therapy. Over 16,000 women between the ages of 50 and 79 took part.

The study showed an increased risk of breast cancer, thrombosis, and cardiovascular disease in women taking HRT. This led to great uncertainty and a sharp decline in prescriptions.

The consequences:

• Uncertainty and fear: women and doctors lost confidence in HRT.
• Avoiding treatment: Many women suffer unnecessarily from menopausal symptoms.
• Research stop: Pharmaceutical companies stopped research into HRT.

But the WHI study also had weaknesses:

• The incorrect age structure of the participants: The participants were on average 63 years old – far from the typical menopause.
• Outdated hormones: Synthetic hormones were used that are rarely used today.
• Study duration too short: The study was terminated prematurely.
• Media scaremongering: The media focused on the risks and neglected the benefits of HRT.

Today we know more and do many things differently

In the meantime, the opinion on HRT has changed again. Numerous studies and analyses have relativized the original conclusions of the WHI study.

"Away from high doses of hormones, towards an individual, gentle compensation of the hormone deficiency!"

• Timing hypothesis: HRT is most effective and safe when started early, ideally in perimenopause or the first few years after menopause.
  • Treat early
  • Check hormone levels regularly.
• Microdosing: The bioidentical hormones are administered in small doses ("as little as necessary").
  • Modern HRT preparations with bioidentical hormones are better tolerated and have a more favorable side effect profile.
  • Use estrogen doses as low as possible.
  • Administer hormones not as tablets, but rather through the skin as best as possible.
  • Treat with natural progesterone instead of artificial gestagens.
• Individualized therapy: Hormone replacement therapy should always be tailored to the individual needs of the woman. The type and dosage of hormones, the form of application, and the duration of therapy are determined based on the individual symptoms and medical history. Users learn to read and interpret their symptoms. With transdermal therapy (via the skin), the woman can determine the "blows", i.e. how much hormones are administered. Hormones fluctuate particularly in the perimenopause. In postmenopause, most women are "adjusted". It is therefore a matter of feeling your way and experimenting with your own feelings, in close consultation with a treating doctor.
• Professional support: It is important that women speak openly with their doctor about the possibility of hormone replacement therapy. Together they can weigh up the pros and cons and make the best decision. Our online doctors provide support here, but they are not a replacement for physical examinations, which are also urgently needed.
• Clarify risks early: Regular monitoring of the breast (risk of breast cancer) before starting and during ongoing therapy is important.
• Prevention: HRT can not only relieve menopausal symptoms but also protect against certain diseases, such as osteoporosis and type 2 diabetes. It is therefore recommended for early menopause (before age 40).

influence on the S3 guideline

The results of the WHI study have had a major impact on the S3 guidelines on hormone replacement therapy. Today, HRT is no longer recommended as a long-term preventive measure for cardiovascular disease or dementia. Instead, the focus is on treating menopausal symptoms.

Conclusion: We need more research on this topic

Research into women's health, particularly menopause, still leaves many questions unanswered. Although studies such as the WHI study have provided important insights, they only cover a small part of the diverse needs and risks of women in menopause.

To help women make informed decisions, we need more research that takes into account different age groups, hormone preparations, and individual risk factors to ensure that women receive the best possible treatment and care.

What we do at hermaid

"Knowledge is the only resource that doubles when shared," said Albert Einstein. And that is exactly our approach at hermaid. We believe in the power of data and information to improve women's health worldwide. Our concept is data-based. We support research projects in the field of gender-specific research and longevity (healthy aging). Together we can help educate women, provide researchers with data, and optimize medical care for women.

• Supporting research projects: We provide data and information to advance research in the field of women's health.
• Developing tools and resources: We develop tools and resources to help women better understand and manage their health.
• Education and information: We provide understandable information on all aspects of women's health, especially menopause.
• Community and exchange: We connect women with each other and promote the exchange on health topics.
  

"Our goal is to support women to live healthy and self-determined lives," says Susanne Feldt, founder of hermaid

Together we can improve women's health!

hermaid is offered as an employee benefits program to support women in menopause:

If you convince your employer to offer hermaid in your company, the service is free for you.