Additional preventive benefit of hormone replacement therapy

Hormone replacement therapy (HR T) can have a positive preventive effect on age-related diseases, such as :

• type 2 diabetes
• cardiovascular disease
• osteoporosis
• dementia
• Alzheimer's disease

This is particularly important when there is an increased risk, or when other specific medications are not tolerated.

As for the many additional preventive benefits of HRT, it is essential to start treatment early enough. It is therefore preferable to seek advice in good time, not only to relieve menopausal symptoms, but also to minimize health risks.

Bone mass gradually decreases with age. The disappearance of estrogen production at menopause can lead to significant changes in bone metabolism in women at this stage of life - which in this case means a further reduction in bone mass(osteoporosis).

A large number of studies show that taking estrogen has a positive effect on bone density and reduces the number of bone fractures. In the Million Women Study, for example, a 25% reduction in fractures was observed after transdermal application of estradiol. ¹

The large-scale Women's Health Initiative (WHI) study of 2002 also showed that estrogen-progestin treatment reduced fracture frequency by 24% for an average treatment duration of 56 years. ^2,3

Very small amounts of estrogen are already sufficient to produce a positive effect on bone balance. The effect obtained with higher doses is proportionally greater.

The Swiss Society for Gynecological Endocrinology and Menopause also affirms that HRT in postmenopausal women requires specific consideration of the benefit/risk ratio. For the prevention of osteoporosis, it recommends in the first instance ⁴:

• adequate calcium intake (1000-1500 mg/day)
• adequate vitamin D intake (800-1200 units/day)
• a balanced diet with adequate protein intake
• regular physical activity

Reducing risk factors such as smoking, excessive alcohol consumption and the use of drugs that influence bone metabolism (glucocorticoids, anti-epileptics, thyroid hormone suppressive therapy).

In the post-menopausal years, the risk of cardiovascular diseases such as myocardial infarction and stroke increases.

There are a number of studies on the influence of HRT on cardiovascular disease, some with differing results. Overall, analysis of the studies shows that early initiation of HRT, i.e. before the age of 60 or within 10 years of the last menstrual period, can have a positive effect on the cardiovascular system in heart-healthy women. ^5,6 A negative effect of HRT depends, among other things, on the condition of the vessels, and is more pronounced in the case of previously damaged vessels. If treatment is started when advanced atherosclerosis has already developed, the positive effects of HRT can no longer unfold.

Diabetes is a popular disease. According to theSwiss Diabetes Association, around 500,000 people in Switzerland have diabetes. Type 2 diabetes is the most common form, and in most cases does not appear until the second half of life. ⁷ Hormonal changes during menopause can increase the risk of developing type 2 diabetes. ⁸

Studies show that hormone replacement therapy (HRT) can reduce the risk of developing type 2 diabetes by around 30%. ^8,9
HRT can also have positive effects in cases of existing type 2 diabetes, as estrogen treatment improves various sugar and fat levels. ⁹

In Switzerland, colon cancer is the third most common cancer among men and the second most common among women. In both sexes, new cases and mortality rates increase with age. According to cancer registry data, an estimated 1,995 women per year were diagnosed with colon cancer in Switzerland between 2015 and 2019. ¹⁰

As HRT compensates for the lack of estrogen due to menopause, it may have a positive effect on the risk of colon and rectal cancer ^11,12, as a summary of several studies shows. The risk of colon and rectal cancer was reduced by 21% in users receiving estrogen-only therapy compared with non-users; in users of HRT combined with progestin, the reduction was even 26%. ¹² Other data indicate that the risk of other types of cancer of the gastrointestinal tract can also be reduced. These include cancers of the oesophagus ^13,14 stomach ¹⁵ and liver.

Whether menopause actually affects cognitive abilities, such as memory impairment, confusion or lack of attention, is still a matter of debate. It is above all advanced age that constitutes a risk factor for the onset of dementia. In Switzerland, an estimated 150,000 people suffer from dementia. Every year, around 32,200 new cases of dementia are recorded. ¹⁶

For a long time, it was unclear whether HRT could promote or rather prevent dementia. Now, several factors point to an "early window of opportunity": the use of HRT in time for this window of opportunity does not increase the risk of dementia; the risk of Alzheimer's disease can probably even be reduced. ^17-19 On the other hand, HRT started late in women over 65 probably increases the risk of dementia because of the vascular changes that have already occurred. ²⁰

New evidence shows that lung function in post-menopausal women declines faster than expected, beyond the age-related decline. This decline does not depend on other risk factors such as smoking or obesity.

The effect can be represented as follows: The decline in lung function during menopause is roughly equivalent to the lung damage caused by smoking 20 cigarettes a day for 10 years. ²¹ Current studies confirm that HRT can significantly reduce the decline in lung function in postmenopausal women. ^22,23