Hormone Replacement Therapy (HRT) for Thyroid Disease: A Comprehensive Guide

Should you go on hormone replacement therapy (HRT)? On one hand, menopausal symptoms are very real and can be quite disruptive, and that’s what they are usually given for. On the other, there are valid concerns surrounding risk (including the risk of breast cancer).

So, is Hormone Replacement Therapy something I usually suggest?

The short answer is ‘no.’ I personally feel the risks are too high. If you do have symptoms and are aware of the risks then I’m totally fine with your choice either way. I’ve found that many who are on HRT are unaware of the risks, so this is for you.

In this article, I want to jump into the details of the most important considerations to make. But, if you just want a quick rundown of the most important points. I hope it helps…

• Hormones reduce hot flashes and night sweats. For young, healthy women, the risks are generally mild.
• Hormones do not improve aging. They do not lower the risk of heart attack, stroke, or cognitive decline.
• The decision whether or not to take hormones should be based on an individual woman’s preferences and personal risk level.

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Table of Contents

What Do We Know About HRT?
What Do We Know Now About Hormone Replacement Therapy?
Should You Do Hormone Replacement Therapy?
Keep This In Mind About Hormones

What Do We Know About HRT?

If we go back to the 1990s, most studies suggested that hormone therapy definitely would help most menopausal symptoms. In addition, there were various health benefits that also came with it, too.

This was when hormones were thought to improve cardiac health. They were also thought to cut the risk of brain aging. This led to many cases of women being put on hormone therapy to help improve their health and deal with symptoms like hot flashes.

Women’s Health Initiative (WHI) Study

Then, everything changed. In 2002, the Women’s Health Initiative (WHI) ran the largest study to date, evaluating hormone replacement therapy. In it, 27,347 women, between the ages of 50-79 were tracked for 5.6 to 7.2 years.

Given the amount of time, this study was often referred to as “the last word” on the subject, as a study like it was unlikely to be run again for some time. It also differed from prior studies in that the people were randomized. Some did hormones while others did a placebo.

It broke down like this:

• Women who had a uterus were given an estrogen pill called conjugated equine estrogen (CEE).
• Women who had had a complete or partial hysterectomy were given a progesterone called medroxyprogesterone acetate (MPA).

The reason this study was run was to answer a big question at play. Mainly, if hormones were making women more healthy, or if healthy women were simply the ones taking hormones. But, when it was done, the study was not expecting to refute or disprove existing ideas.

Instead, researchers were more expecting to refine and determine exactly how helpful hormones were – and not question their helpfulness at all. However, when women were randomly assigned, everything changed.

They found that the healthy-user bias was bigger than they thought, and the health benefits they initially believed to be there completely eroded away.

They looked at health outcomes in terms of control of menopausal symptoms (meaning systemic symptoms like hot flashes or night sweats), as well as various health outcomes like:

• Cardiovascular disease risk
• Cognitive decline
• Cancer risk
• Bone health

What they saw was that hormones did not improve health risk. There was no large benefit, and in fact there was harm in terms of cardiovascular health and cancer risk.

We can break this study down into four unique segments:

1. Younger women (40-50)
2. Older women (60-70)
3. Women who had uteruses
4. Women who did not have uteruses

The summaries of the findings as part of these differences included:

• Heart disease – Women on estrogen and progesterone had a higher risk of heart attacks, pulmonary embolism, and strokes.
• Breast cancer – Hormone therapy caused higher rates of breast cancer.
• Hip fracture – Hormone replacement lowered the risk of hip fracture in younger women, but not older women.
• Cognitive impairment – Estrogen + progesterone increased the risk of cognitive impairment.
• Total mortality – Hormone replacement showed no benefits for total mortality.

A lot of questions have come up since then. There are many who are strong advocates for natural hormones. They have looked at this study, and embraced the good while shying a bit away from the bad. I don’t think you can really do that.

On one hand, they have found that hormones are good for helping symptoms and protective in certain ways (based on older data). But, when things go bad, it’s typically chalked up to being on different types of hormones.

What Do We Know Now About Hormone Replacement Therapy?

As a quick recap, cardiovascular disease is worse for those on hormone replacement therapy (heart attack, congestive heart failure, stroke, and pulmonary embolism). At the same time, breast cancer risks are also higher. These are all clear risks.

For some women, these risks are more identifiable than others. They may have a strong family history, genetic clotting issues, higher lipids, higher blood pressure, all of these things can lead to more potential issues and higher potential risk.

The same is true for breast cancer. Due to things like body weight, family history, and other considerations like alcohol intake. These remain relevant factors.

In terms of numbers, this really adds up to a few cases per 1,000 in younger women. So, it’s not a guarantee that if you take hormones you will get cancer. Far from it. It is also a reasonable consideration for younger women with low risks and bad symptoms.

But, when the risks are higher, it is something women should be informed of and should be taken into account.

The Issue with Bone Loss

I want to take a moment to talk about something important: bone loss. Estrogen does help bone health, and it was shown that younger women in the WHI study found that younger women had better bone health when they were on hormone replacement therapy.

There’s a couple of wrinkles here, though. One of them is that the duration of benefit is thought to be no longer than the duration of hormone usage.

That means that if the women were to have stayed on hormones longer, into their ages in which bone risk is apparent, the concern is that the cumulative years would have made the overall side effects greater.

And, as it was, there was no net benefit for mortality. If there was a way in which benefits to bone health outweigh the detriments of cancer or heart disease, it didn’t happen. And, there is little reason to believe they would have happened if they had gone on longer.

Ultimately, hormones should not be considered a good strategy for maintaining bone health. A lot of other things are, but hormones are not due to their lack of net, overall benefit.

The Issue with Vaginal Symptoms

There are also vaginal symptoms that women have, including:

• Atrophic vaginitis
• Dryness
• Pain during intercourse

Systematic, whole-body hormone replacement therapy does not consistently help with vaginal symptoms. But, there are topical therapies that can help.

They work locally, they act on the vaginal lining, and they do not spread hormones throughout the remainder of the body.

The Issue with Skin Health

While this was not looked at in the WHI study, it is known that systemic hormone therapy can improve skin health. There can be less fine lines, less wrinkling and healthier collagen levels.

Thankfully, there are versions of estrogen that are safe, are non-prescription, and work locally and not throughout the body. They can maintain skin health without the risks of HRT.

Should You Do Hormone Replacement Therapy?

Should you take hormones or not? It is your call. A lot of things can help with hot flashes and night sweats, including:

• Dietary therapy
• Reductions in alcohol and caffeine
• Better exercise

But, they may not be able to help 100% and may not work for everyone. There are also instances where people don’t want to pursue these changes.

In those cases, HRT does often work, but not always. I have practiced quite a bit and used it extensively, but there are those that simply do not respond to it.

This is not common, but somewhere around 5-7% of women with menopausal symptoms do not benefit from hormone replacement therapy. But, most do.

Of course, it’s about understanding the benefits and the risks (including your own unique risks) in tension with one another, and making the best decision for your health from there.

Keep This In Mind About Hormones

From today’s article, I want to communicate one key insight:

Hormones on their own do not create benefits. That is pretty clear.

If you are taking them for health benefits, I would even ask you to reconsider. If you do have symptoms and you understand the risks, that’s totally fine.

But, if you are taking them to lower some factors of aging, it may be time for a rethink. That data is no longer present and the risks outweigh the benefits.

If you want to get a sense of where things stand with your health, I’d recommend taking my handy Adrenal Quiz. It only takes a few moments, and it can be a real game-changer when it comes to your health and understanding your body.

P.S. Whenever you are ready, here is how I can help you now:

1. Schedule a Thyroid Second Opinion with me, Dr. C, Click Here for Details
2. Need A Thyroid Supplement Recommendation? Take My Thyroid Specific Formulations Quiz Now
3. Need a Personalized Supplement? Check out My Thyroid Specific Formulations
4. Download and use my Favorite Recipes Cookbook Here
5. Check out my podcast Medical Myths, Legends, and Fairytales Here

Dr. Alan Glen Christianson (Dr. C) is a board-certified Naturopathic Endocrinologist, and the author of The NY Times bestselling Adrenal Reset Diet, Metabolism Reset Diet, Thyroid Reset Diet, and the Healing Hormone Cookbook.

Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.