Hormone replacement therapy, or HRT, has been controversial for quite some time. In the 20th century, women were often admonished that taking estrogen and progestin after menopause would not only ease hot flashes, but also keep their bones, hearts and brains healthy as well. This idea goes back at least to the 1960s, when Dr. Robert A. Wilson published Feminine Forever. In it, he argued that women could stay youthful, sexy and healthy by using HRT. Needless to say, many women loved the idea that they would be able to prevent wrinkles, avoid vaginal dryness and maintain their health.
The Women’s Health Initiative:
A study published in 2002 disappointed women and their doctors. In 1991, the Women’s Health Initiative assigned about 160,000 women to take HRT or placebo. The researchers wanted to learn how well the hormones worked to keep bones strong and prevent heart attacks. They were also collecting data on side effects such as breast cancer and endometrial cancer. To their surprise, the hormones increased the risk of heart problems and strokes. Although women taking HRT had stronger bones, those taking the combination of estrogen plus progestin had a higher risk of breast cancer. Those on estrogen alone were less likely to develop breast cancer. The investigators looked at many other factors, but they did not consider whether HRT could prevent wrinkles.
Will HRT Help Prevent Wrinkles?
Q. I just read your column that says taking calcium and vitamin D doesn’t strengthen bones. I didn’t buy the recommendation so I’ve never taken either. My theory is, if you want strong bones, run, walk, and jump up and down.
But at one time my OB-GYN doctor told me that if I wanted to keep strong bones and look youthful, I should take hormone replacement therapy. My doc up north said that was nonsense.
However, my two women friends who take HRT look fabulous at 70, whereas I started looking like the proverbial withered hag in my mid-50s after menopause. Coincidence? Genetics? I wish I had followed the advice of the first doctor. My bones are OK, but my face! What say you?
HRT Might Slow Skin Aging:
A. Hormone replacement therapy may slow skin aging and reduce the likelihood of osteoporosis (Piérard et al, BioMed Research International, Dec. 21, 2013). That said, possible side effects such as blood clots, gallbladder disease, breast cancer and heart disease should be considered before starting HRT for cosmetic purposes (US Preventive Services Task Force, JAMA, Dec. 12, 2017). The usual recommendation is that HRT can be used to ease hot flashes. It is quite effective for that purpose. However, experts advise women to take the lowest effective dose for the shortest feasible time.
Recent research suggests that a set of facial exercises, practiced faithfully for eight months, may be able to help people appear more youthful (Alam et al, JAMA Dermatology, online Jan. 3, 2018). Hopefully, these will become better known so that we can all reduce or prevent wrinkles without fear of serious side effects.