HRT or natural therapies – do I have to choose?
HRT (hormone replacement therapy), also known as MHT (menopausal hormone therapy), is having a bit of a moment – and rightly so. HRT can be very beneficial to deal with annoying perimenopause symptoms, and it should not be feared. Many women over the last 2 decades were not offered HRT or didn’t want to ask about it because of the now infamous WHI (Women’s Health Initiative) study. Others might argue that HRT is not necessary and that symptoms can be managed with diet and lifestyle changes plus herbs and supplements. So is there a right or wrong answer?
The controversy
This study reported that HRT increased the risk of breast cancer, heart disease, and stroke — which understandably sounded alarming at the time. However, when the data were examined more closely, several major flaws in the study’s design became apparent.
Firstly, the study population consisted almost entirely of women who were, on average, 10 years past menopause, with a mean age of 63. This age group is already at a higher baseline risk for heart disease, making it difficult to conclude that HRT alone was responsible for the observed increase in cardiovascular events. In clinical practice, HRT is generally initiated much earlier — ideally before the age of 60 — partly to help prevent the rise in heart disease risk seen after menopause. Despite this, the study’s findings were generalised to all women, regardless of age or timing of treatment.
Secondly, the type and route of hormones used were also problematic. The study used an oral combination of synthetic conjugated equine estrogens and synthetic progestins in women with a uterus (and estrogen alone in women without one). Today, HRT is usually prescribed in more physiologically appropriate, body-identical forms, which can be delivered orally or transdermally, and are tailored to each woman’s individual needs.
It’s also important to clarify the reported breast cancer risk. The study claimed a 26% increased risk, which sounds significant — but in absolute terms, this equates to fewer than one additional case per 1,000 women per year. And crucially, this risk applied only to the older oral synthetic formulations, not the modern body-identical therapies commonly used today.
Why should I consider HRT?
HRT directly replaces declining hormones (mainly estrogen ± progesterone, sometimes testosterone) during perimenopause/menopause. As discussed above, these days generally doctors use body-identical hormones as first-line treatment because they are the safest and most effective form of hormone therapy. They have the same chemical structure as hormones produced by the ovaries, and are naturally derived from vegetables (yam or soy bean).
HRT can be highly effective for symptoms like hot flushes, night sweats, vaginal dryness, mood swings, and for long-term bone protection and prevention of osteoporosis. HRT is cardioprotective, which is an important consideration given that one of the leading cause of death for Australian women is heart disease. It also appears to protect against dementia, which is the other leading cause of death for women.
Does that mean I don’t need to worry about diet and lifestyle changes?
No, a good diet and lifestyle are still just as important. A nutritious diet and supplements/herbs can support overall wellbeing while HRT addresses the root hormonal deficiency. Nutritional and herbal support can also reduce the dosage of HRT needed or help manage symptoms HRT doesn’t fully resolve (like energy, sleep, or gut health).
In this context it is important to work with a qualified naturopath/nutritionist. They can work with your GP to ensure that treatments are coordinated and safe. A naturopath/nutritionist will ensure that what you are taking is addressing your individual symptoms, that you are getting the correct dosage and the product you are taking is a good quality one.
For full transparency, I take HRT myself — primarily for bone health and osteoporosis prevention. Because I have osteopaenia, protecting my bones is a top priority. Alongside HRT, I also see my naturopath regularly. He prescribes a customised herbal tincture each time, based on whatever symptoms I’m experiencing at that point. I support this further by eating a nutrient-rich diet (focusing on the key nutrients I’ve outlined in this blog post), by moving my body every day and sleeping 7-8 hours at night.
The bottom line
The bottom line is that you don’t have to choose between HRT and natural therapies. Many women find they feel their best with a combined approach that’s tailored to their individual needs and health goals.
Ultimately, the decision about whether to start HRT is a personal one. What’s most important is that you seek out reputable, evidence-based information and try to form a balanced view of your options before making your choice.
Here are some helpful websites to get you started:
