Menopause and Hormone Replacement Therapy - March 2026 Newsletter
Menopause and Hormone Replacement Therapy
Hello, this is Dr. Ellen. In this month’s newsletter, I want to take a look at the use of hormone replacement therapy to decrease unwanted symptoms and bone thinning related to menopause. There are a number of controversies regarding this therapy. Perhaps the most important is how to minimize the potential adverse effects of the therapy. Another, which may overlap the first, is the use of bioidentical vs. synthetic hormone(s). I will touch on each of these below.
By the way, if you haven’t had a chance to see my previous newsletters, you can find them on my website, www.drellencutler.com under ‘Free Resources’.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) replaces declining ovarian hormones through the menopause transition to relieve the resulting symptoms, particularly vasomotor changes such as hot flashes, and genitourinary changes such as vaginal dryness. HRT is also used to prevent postmenopausal bone loss, including initial bone loss (osteopenia), which can worsen into osteoporosis with an increasing risk of bone fractures. Decreasing estrogen can also promote central adiposity and insulin resistance, adversely affect blood vessel (endothelial) function and blood lipid profiles, and may be accompanied by transient verbal and/or memory difficulties during the transition.(1)
The two primary hormones replaced by HRT are estrogen and progestogen. One type of estrogen naturally produced by the body is 17β-estradiol (aka ‘E2’). The bioidentical version can be derived from plant sources such as soy, and can be delivered in different forms, including micronized oral versions, transdermal patches, sprays, or gels (the last of these being used especially for vaginal symptoms). However, also available are non-identical estrogens, such as conjugated estrogens (typically derived from pregnant horse urine) and synthetic conjugated estrogens, each of which may act similarly to the bioidentical version, but also can interact with receptor sites on cells in a different manner and contain dissimilar hormones as well. The other major hormone is a progestogen, which can be either the bioidentical form produced by the body, progesterone (which can be derived from yams), used in a micronized of topical form; or synthetic versions (progestins), commonly medroxyprogesterone acetate or norethindrone. Again, the synthetic forms can act differently in the body than the bioidentical version. Also, for some women with decreased libido, transdermal testosterone may be added as well.(1)
Estrogen therapy (ET) is usually recommended for women without a uterus, whereas estrogen–progestogen therapy (EPT) is used for those with an intact uterus to protect its inner lining (the endometrium). Women still experiencing periods or who have had a period in the past 12 months are usually given cyclical HRT containing estrogen and progestogen and will likely have a period every month. If natural periods stopped more than one year ago, continuous HRT is used, which provides estrogen and progestogen throughout the cycle. Optimal dosing of HRT aims to achieve the lowest effective dose.(1,2)
The History of HRT
Premarin, derived from pregnant mares’ urine, was the first HRT approved by the U.S. Food and Drug Administration (FDA) for the treatment of menopausal symptoms in 1942. Premarin use surged until 1975, when the association was made between unopposed estrogen use and endometrial cancer. By the early 1980’s, it was found that adding a progestin to continuous Premarin would prevent overgrowth and carcinoma of the endometrium. Use again surged to help millions of women entering menopause relieve their hot flashes, night sweats, and vaginal symptoms. There were also reports of prevention of osteoporosis and other studies suggesting a reduction in cardiovascular morbidity and mortality. However, the Framingham Heart Study suggested increased risk of cardiovascular disease (CVD) in women taking conjugated equine estrogen and medroxyprogesterone acetate, both synthetic. Because of these differences in results, the Women’s Health Initiative (WHI) was funded to determine if all women would have decreased risk of CVD with these two hormone. However, only an older population of women was studied, and the results reported in 2002 suggested possible increased risk of CVD (stroke) and breast cancer. Prescription of the two synthetic hormones was subsequently greatly curtailed following this.(3,4)
Since the WHI
The subject of HRT has become better defined since 2002, but remains controversial and awaits further studies. Prescribing needs to be based on the individual patient, timing, route, and dose. Generally speaking, HRT provides the most effective relief of vasomotor symptoms and is the first-line treatment for genitourinary syndrome of menopause, particularly with the use of low-dose local vaginal estrogen preparations. It also may help prevent early postmenopausal bone loss and therefore reduce fracture risk. HRT may also confer modest improvements in sleep, mood, and quality of life.(1)
Benefit vs. risk ratio depends on the hormone(s) used, timing, route, and dose. Initiation within 10 years of menopause as well as the use of transdermal estradiol at low to moderate doses are favored when cardiovascular or thrombotic (i.e., blood clotting) risk is of significant concern.(1) One study showed lower major adverse cardiovascular events in women on estradiol and micronized progesterone compared with conjugated equine estrogen and medroxyprogesterone acetate.(5) Oral regimens—particularly those using conjugated equine estrogens—are associated with higher risks of venous thromboembolism and stroke compared to transdermal 17 β-estradiol, and risk also varies by the type of progestogen used.(1) Effects on breast cancer risk are specific to the specific regimen - neutral to favorable with estrogen-alone after hysterectomy, neutral with added bioidentical micronized progesterone, but increased risk with added synthetic progestins.(1,6) The absolute risk of ovarian cancer remains small.(1)
One of the larger studies since WHI was a randomized controlled trial of over 1,000 healthy women, aged 45-58, who were recently postmenopausal or had perimenopausal symptoms. It was published in 2012. After 10 years of randomized treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke.(7)
Ellen Cutler Method (ECM)
Over my years of practice, I have repeatedly found ECM energetic testing and clearing methods to be quite effective in mitigating many of my patients’ persistent problems as well as optimizing their overall health. Through ECM testing I can determine the nature of their menopausal complaints and then test them to find if there are specific reactivities related to their problems. This includes testing specific hormones, both those produced by the body and those taken to replace deficiencies. In those with menopausal symptoms, this step is necessary to maximize positive change. Even with these, many individuals may require being desensitized to them to achieve optimal benefit. Once discovered, I use ECM clearing methods to desensitize any identified reactivities, including those to the specific hormones in question, usually with gratifying results.
Please be well, be healthy, but remember…
“Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animalderived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly.”
― “The Bioidentical Hormone Debate” (2009)
https://www.tandfonline.com/doi/abs/10.3810/pgm.2009.01.1949
Dr. Ellen
References:
“Menopausal Hormone Therapy—Risks, Benefits and Emerging Options: A Narrative Review” at https://www.mdpi.com/1422-0067/26/22/11098
“Hormone Replacement Therapy (HRT) explained” at https://www.youtube.com/watch?v=S2ZxBBQPaCo
“A Contemporary View of Menopausal Hormone Therapy” at https://cme.lww.com/files/AContemporaryViewofMenopausalHormoneTherapy-1718207786634.pdf
“Hormones for menopause are safe, study finds. Here's what changed” at https://www.npr.org/sections/health-shots/2024/05/01/1248525256/hormones-menopause-hormone-therapy-hot-flashes
“Major adverse cardiovascular events risk in menopausal women treated with oral estradiol/micronized progesterone versus conjugated estrogens/medroxyprogesterone: a claims data analysis in the USA” at https://pubmed.ncbi.nlm.nih.gov/40773298/
“HRT and breast cancer risk” at https://www.bmj.com/content/367/bmj.l5928/rr-3
“Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomized trial.” at https://www.bmj.com/content/bmj/345/bmj.e6409.full.pdf
* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, mitigate, or prevent any disease.
