In this clarifying article, Dr. Simone Silver directly addresses the pervasive fear surrounding Menopausal Hormone Therapy (MHT), tracing its roots back to the flawed and widely misinterpreted Women’s Health Initiative (WHI) study of 2002.
Dr. Silver explains that the WHI study’s alarming conclusions, which linked MHT to increased risks of breast cancer, heart disease, and stroke, were based on a problematic study group. The participants were predominantly over 65 and had pre-existing risk factors, and many started treatment more than a decade after menopause, a period now known to carry higher risks. Crucially, the study used only one type of synthetic hormone, ignoring the nuanced effects of different formulations.
The article provides a modern, accurate perspective on the two primary risks patients worry about:
- Clotting: The risk of stroke or blood clots is significantly reduced when estrogen is delivered topically (via patches/gels) rather than orally. Furthermore, natural (micronised) progesterone appears to carry a lower clotting risk than synthetic progestins.
- Breast Cancer: The risk is complex and depends on the type, dose, and duration of therapy. While combined MHT (estrogen and progesterone) can slightly increase risk, the type of progesterone matters greatly. Dr. Silver notes that natural progesterone may offer a safer profile and even provides benefits like improved mood and sleep, unlike some synthetic versions.
Dr. Silver’s core message is one of empowerment through personalised care. There is no universal risk; instead, a woman’s individual health profile, genetics, and lifestyle must guide the choice of hormone type and delivery method. She concludes that with proper screening and a tailored approach, MHT can be a safe and effective tool, allowing women to transition through menopause with confidence and vitality.
Original Article: Lets talk about sex hormones baby! featuring Dr. Simone Silver, published in Fairlady, December 2018.
