Hormone Replacement Therapy, What Every Woman Needs to Know in 2026 | Dr. Heather Hirsch

**Dr. Heather Hirsch** (0:00)
The leading cause of death in women is heart disease. This to me is a huge reason to consider menopausal hormone therapy. So what estrogen does is it opens the blood vessels, so you get better blood flow, and that is preventing cardiovascular disease. And they have improved cognitive function at the time at which they started.

**Dr. Gabrielle Lyon** (0:19)
There is an increased risk for dementia or other cognitive challenges when individuals are devoid of hormones.

**Dr. Heather Hirsch** (0:25)
They have all seen their parents struggle with cognitive decline, Alzheimer's and dementia, something I actually going through in my own life.

**Dr. Gabrielle Lyon** (0:37)
What are women doing wrong?

**Dr. Heather Hirsch** (0:39)
As a society of women, we stay in the suffering period for far too long. And we've really normalized suffering, putting on a face and just getting the things done. However, sometimes that can be as a dead tremendous.

**Dr. Gabrielle Lyon** (0:52)
I don't care how much you work out, I don't care how well that you eat. If we're talking about estrogen's impact or even testosterone, they have certain receptors that are only going to be affected by those hormones. The biggest concern I hear patients say is they're concerned about breast cancer with estrogen cancer.

**Dr. Heather Hirsch** (1:09)
We've never actually proven that estrogen itself causes breast cancer. Sounds almost criminal to say it out loud, but it'll say, this idea that estrogen is dangerous and harmful truly came from.

**Dr. Gabrielle Lyon** (1:33)
Dr. Heather Hirsch, Dr. Lyon. You're a superstar, and I want to share with you where I first saw you live and in action.

**Dr. Heather Hirsch** (1:41)
Oh, where?

**Dr. Gabrielle Lyon** (1:43)
FDA. You were on an expert panel, doing some extremely important work, and really changing the perception of hormone replacement therapy.

**Dr. Heather Hirsch** (1:50)
Yeah, that was such an important moment. Actually, I've been on stages before, but I was not as nervous for anything else as I was before that camera panned to me, because I knew that thousands of women were going to be watching live. This panel, which was a group of expert clinicians coming together to speak with Commissioner Marty McCary about the safety of hormone therapy, had a lot of stakes involved, and so I was also opening that. I really wanted to kick it off and really make a nice impression and set the stage for the rest of my amazing colleagues to then do their work.

**Dr. Gabrielle Lyon** (2:25)
You really did a fantastic job, and I recommend that anyone who is listening or viewing this, check out that it is available and we'll link it. Hormone replacement therapy for women.

**Dr. Heather Hirsch** (2:35)
Yeah. Huge topic.

**Dr. Gabrielle Lyon** (2:37)
What happened and where are we at right now?

**Dr. Heather Hirsch** (2:41)
The story of hormone replacement therapy is an interesting one, and it's more a media frenzy and a little bit of myth than there is an actual scientific story that goes along with it. In the late 1980s and early 1990s, the majority of women were on hormone replacement therapy. Actually, it's good to define what hormone replacement therapy is. I think that's always excellent to do. Typically, it means an estrogen and then plus or minus a progestin or progesterone if a woman has an intact uterus, although you can take it even if you don't, and then plus or minus testosterone, and then sometimes plus or minus vaginal estrogen. Menopausal hormone therapy can be a wide range of things. Most women were given estrogen as the key component of hormone therapy in the 80s and 90s. In 1992, the American College of Physicians, like at their annual meeting, strongly advocated that most women take estrogen shortly after menopause. However, there was no randomized controlled trials yet, but prospectively, the clinicians were seeing that the women who were taking hormone therapy were living longer, having bitter bones, and having less heart disease. They went to the NIH and said, we got to put together a randomized controlled double-blinded study. So they enrolled thousands of women. Actually it's one of the biggest randomized controlled trials we've ever had. The NIH spent billions of dollars over multiple sites. Now inherent in that was they got women enrolled in the study who are closer to the age of 62 or 63 So on average, 12.3 years later than the average age of menopause, which was 50 It's now 51 It's actually slightly breaking upwards.
They gave women one dose and one formulation of hormone therapy. So if you didn't have a uterus, you could take Premarin and that was conjugated equine estrogen 0.625, and you took that alone without a progestin. Then if you did have a uterus, you were given Prem Pro, actually at the same estrogen dose 0.625 of conjugated equine estrogen, and then Madroxyprogesterone acetate. So this study sets the stage for what will happen in a few years in 2002 In the summer of 2002, a press report was held where they said hormone therapy is dangerous. What they said is that it increased the risk of breast cancer, but it was only in the women on estrogen and progesterone. The women in the estrogen only were actually doing great. No safety threshold was crossed there, but they were noticing increased diagnosis of breast cancer. And the media reported a 26% increased risk of invasive breast cancer.