Is Hormone Replacement Therapy Safe?

Updated: Aug 31, 2021

As women begin to go through menopause, conventional medicine tells them they have to choose between suffering through the symptoms or “risking hormone replacement.” Some conventional providers will prescribe hormone replacement and say it is safe but “only for five years” or “only until age 55.” With these conflicting messages, many women are left asking themselves: Are hormones safe after menopause?

The short answer to this question is “hormone replacement can be safe.” Women need to be educated to understand what makes hormone therapy safe and unsafe. Factors that can cause hormone replacement to become unsafe include:

  • a “one size fits all” approach

  • hormone replacement that is not closely monitored with appropriate lab testing

  • over replacement of hormones (making levels too high)

  • utilizing progestins rather than bioidentical progesterone

  • estrogen replacement that is given by mouth

  • hormone replacement that is not part of an overall health plan including diet and lifestyle support

Let's explore each of these factors in more detail to help better understand how hormone replacement can put you at risk and how we help you safely navigate hormone replacement so you can stay healthy and balanced.

“One size fits all” approach

Each woman is unique, so her symptoms, lifestyle, stressors, diet and personal experience during the perimenopausal and menopausal phases must be considered. Her personal levels of hormones should be tested along with a diet and lifestyle assessment, history (personal and family) and physical exam. Understanding the function of hormones in the body as they relate to symptoms helps guide a functional medicine provider to develop an individualized treatment plan.

Through my years of working with women and testing their hormones, I can honestly say that symptoms MUST by put in the context of lab values and lifestyle. Women with the exact same symptoms can have completely opposite lab results. Therefore, starting both women on the same treatment will help one woman and make the other feel much worse.

Not only do we have to put symptoms in the context of lab values, we must understand the effect lifestyle has on hormone levels and how they are metabolized (breaking down). Remember that as messengers, hormones are influenced by the environment of the body in which they are produced. Balancing a woman’s hormones based on looking at labs and not the whole person is not an effective way to manage hormone therapy and can actually even cause symptoms and increase risk.

At Elevate we evaluate the whole person. We understand the need to assess the entire woman including her symptoms, lab values, lifestyle, diet, medical history and stressors. Each woman is treated as an individual and has a personalized treatment plan developed to meet her unique needs.

Monitoring hormone levels with lab testing

Lab testing is an important part of monitoring hormone replacement therapy. Ensuring levels are staying in a safe range is necessary to minimize the risk of therapy and to ensure proper response to medications. Measuring lab levels can also provide an insight into how diet and lifestyle choices can be aiding or inhibiting the benefits of hormone replacement.

It is important to remember that the goal of hormone replacement in menopausal women is not to maintain fertility but rather to diminish the effects of aging. Maintaining strong bones and adequate muscle mass, decreasing cholesterol, decreasing memory loss and maintaining heart health are the goals of therapy. Routine lab testing ensures adequate levels of hormones to meet these goals, but not high enough to place a woman at risk.

At Elevate we understand the myriad of lab values necessary to ensure appropriate information is gathered. Lab testing may be completed using either blood, saliva or urine – or any combination. Labs are ordered after a woman has spoken with one of our providers, to ensure the proper information is gathered.

Over-replacement of hormones

When hormone levels are not properly monitored, chaos can ensue in a woman’s body. Remember that hormones not only have their individual jobs to do, but they also are a part of the “hormone cascade,” meaning that they convert into other hormones or substances (metabolites). Replacing too much of one hormone can affect the levels of all the other hormones and can cause higher levels of dangerous metabolites.

For example, I have seen women placed on too much testosterone. Initially these women can feel really great (tons of energy and libido) and then the side effects creep in. They become irritable, develop acne, can get sore breasts, lose hair on their head and start to grow dark hair on their face. These high levels of testosterone convert into estrogen, raising their estrogen levels. Testosterone also converts into dihydrotestosterone and causes acne, hair loss from the scalp and hair growth on the body and face.