TO HRT OR TO NOT HRT? A serious look at Hormone Replacement Therapy.

What did we as women do before Hormone Replacement Therapy? Did we not need it? Is it possible that our symptoms worse in 2010 because of our western diet and lifestyle? Are we too busy to want to overcome the challenges and deal with the changes that come with menopause because of our hectic busy fast paced lives? Are symptoms worse because of the lack of awareness within our own body? Are we resistant to our bodies’ natural aging progression and changes? We live in a society where appearance carries so much weight; so does taking HRT make us feel younger and more youthful? But seriously, what did women do hundreds of years ago? How did they deal with the hot flashes and other menopausal symptoms--symptoms which we feel as modern women, need to be medicated?

To HRT or to not HRT? For Naturopathic Doctors, this is a very common inquiry. Patients are curious about alternatives to Hormone Replacement Therapy (HRT), complications of HRT, and alternative treatments to give menopausal relief. Women are getting conflicting advice from their varied health practitioners and are left confused and unaware of what the right option is for them to relieve their menopausal symptoms.

HRT made its debut in the 1950s. It began to rise in popularity however in the 1970s with increased prevalence in the 1990s. HRT is either given as estrogen alone or in combination with progesterone. These hormones are preferably given in combination as estrogen alone can increase the risk of endometrial cancer.

Several studies in the late 1990s, opened our eyes to the notion that HRT could lead to uterine and breast cancer. This theory exploded and numerous studies were completed to further examine the possibilities. Currently, the connection between HRT and cancer is listed on every website promoting HRT drugs and can be found in medical journals. Femhrt (ethinyl estradiol tablets) which is a combination of estrogen and progesterone, created by Warner Chilcott pharmaceutical company, states on their website that Femhrt may cause “breast cancer, cancer of the uterus, stroke, heart attack, blood clots, dementia, gallbladder disease, ovarian cancer” ( Premarin, a common estrogen derived from the urine of pregnant mares, manufactured by Wyeth pharmaceutical company, is used to treat moderate to severe menopausal symptoms. On their website it states: “estrogens increase the chance of getting cancer of the uterus. Using estrogens, with or without progestins, may increase your chance of getting heart attacks, strokes, breast cancer and blood clots” ( Hormones from pregnant mares are not the same molecules as the hormones in our bodies and soon after the introduction of Premarin in 1969, a sharp increase in endometrial cancer was observed.

Here’s some food for thought - In 2000, 46 million prescriptions worth $1 billion were written for Premarin, making it the second most prescribed drug in the US after Lipitor (cholesterol lowering drug) made by Pfizer. In a study conducted by the Women’s Health Initiative in 2002, it was found that compared to placebo, estrogen plus progestin resulted in : increased risk of heart attack, increased risk of stroke, increased risk of blood clots, increased risk of breast cancer, increased risk of dementia and no protection against mild cognitive impairment. The same study concluded that long-term use of estrogen and progestin increased a woman's risk of a stroke by 41 per cent, of a heart attack by 29 per cent, and of breast cancer by 24 per cent. With this the FDA states that: “hormone therapy should be

used at the lowest dose for the shortest duration needed to achieve treatment goals. Also, postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks with their physicians before starting treatment” ( In a study by Beral et al., they confirmed the theory that the length of treatment affected the outcome. The study revealed that the longer the use of HRT, the greater the incidence of cancer of the breast and endometrium (Beral, 1999). As if further evidence is needed, a brand new study was published in May 2010 by Renard et al., noting a decline in breast cancer incidence with a decline in the use of HRT in Belgium (Renard, 2010). If the question of whether or not there is a link between cancer and HRT, the resources in this article alone should be sufficient evidence for you to make an empowered and educated decision about your health.

As for alternatives, talk to your ND about phytoestrogenic herbs, acupuncture and homeopathy to treat your menopausal symptoms. Daily ground flax and soy are beneficial at reducing hot flashes as well. Consider this: Hot flashes affect 75% of North American women. However, less than 10% of women in Japan are affected (Kaur, 2005). Now compare dietary differences. The lignans in flax have estrogenic activity and the isoflavones, genistein and daidzen, in soy have the ability to weakly bind to estrogen receptors in the body. These factors work to increase bone density, decrease the number of hot flashes, decrease sleep disturbances and decreases the amount of TNF (cytokine found in cancer). Avoiding dairy, gluten, caffeine, sugar, caffeine, and alcohol can do wonders for reducing the severity of hot flashes and other menopausal symptoms. As can decreasing stress, meditation, exercise, performing yoga and embracing the natural aging process J

As a health care practitioner I have seen breast cancer in patients with no known risk factors other than using HRT. This clinical evidence is hard to ignore and should be available to anyone who is debating on how to handle their menopausal symptoms. Be empowered. Be educated. Look into other alternatives. Talk to your MD. Talk to your ND. Take your health into your own hands. Just remember the alarming evidence when you decide if it’s really worth it?

Stay tuned for part two where we will go more in depth on natural alternatives!

Yours in health,

Dr. Sarah Hawthorn, BAS, ND


1. Beral et al. “The use of HRT and the subsequent risk of cancer”. J Epidemiol Biostat. 1999. Vol 4 (3).

2. Kaur, Dharam Sat. “The Complete Natural Medicine Guide to Women’s Health”. Robert Rose. 2005.

3. Lambe et al. “Reductions in the use of hormone replacement therapy: effects on Swedish breast cancer incidence trends only seen after several years”. Breast Cancer Res Treat. June 2010. Vol 121 (3). 4. “Women’s Health Initiative”. Department of Health and Human Services. 2010. 5. “Premarin”. Wyeth Pharmaceuticals Inc. 2009.

6. Renard et al. “Decline in breast cancer incidence in the Flemish region of Belgium after a decline in hormonal replacement therapy”. Ann Oncol. May 2010. 7. Warner Chilcott. 2009.



Dr. Sarah Hawthorn, ND is a Naturopathic Doctor. She completed her undergraduate honours degree at the University of Guelph in Biomedical Science and Music. She then went on to complete the four year naturopathic medicine program at the Canadian College of Naturopathic Medicine (CCNM) in Toronto. During her internship at CCNM, she worked at the Sherbourne Health Centre for HIV patients. She also has additional training in Facial Rejuvenation Acupuncture and has studied with herbalist, John Redden. Sarah currently practices in Cambridge, ON. Sarah is a licensed Naturopathic Doctor and is registered through the Board of Directors of Drugless Therapy – Naturopathy . She is also a member of the Ontario Association of Naturopathic Doctors (OAND) , the Canadian Association of Naturopathic Doctors (CAND) , the Ontario Herbalists Association (OHA) and the Cambridge Chamber of Commerce. Website :