"HRT" is the INCORRECT Terminology

Here's Why

Words matter. And words have precise meanings. I am probably more sensitive to this than most people. When I ask the guy in the produce department if there is any more arugula and he says, “I’ll double-check” it’s all I can do not to say, “No need to double-check, just single check, and do it right the first time”.

Or when the salesperson asks me for my credit card and I hand it to her and she smiles brightly and says, “Awesome!!!” I want to let her know that handing her my credit card was not worthy of awe, and she should save “Awesome!!!” for when I figure out how to cure cancer or reverse climate change.

But I let it go. We have way more important problems in the world.

But the one I can’t let go is the constant misuse of the phrase- Hormone Replacement Therapy- AKA “HRT”. It makes me crazy when I hear it, which occurs an average of 10,000 times per day because of what I do. At least, it seems like that.

HT, MHT, and HRT are often used interchangeably. But they are not the same thing.

Hormone Therapy-HT

Any time you add hormones to the body, in any amount, it is hormone therapy. The most common form of hormone therapy prescribed in the United States is birth control pills. Birth control pills are high-dose estrogen and progestogen to suppress ovarian function (to provide contraception) or to control cycles such as in perimenopause. Oxytocin is an example of a hormone therapy that is intended to boost normal levels, such as when it is given to facilitate uterine contractions in labor.

Hormone Replacement Therapy-HRT

Hormone replacement therapy is replacing a hormone that the body no longer makes in a dosage that matches the level that the body used to make on its own. Thyroid hormone, for example, is administered when someone has an underactive thyroid gland, or has had their thyroid gland surgically removed. Another common example is insulin. When prescribing replacement hormone, the goal is to replicate normal physiologic levels.

Notice what’s not on the list? Post menopause estrogen and progesterone. HRT is not the correct terminology

Menopausal Hormone Therapy-MHT

MHT is a specific type of hormone therapy that is intended to supply small amounts of estrogen, progesterone, and sometimes testosterone. However, the amount of estrogen prescribed is not meant to reproduce the levels that were typically achieved pre-menopause. Small amounts of hormones are used to alleviate symptoms like hot flashes or consequences of estrogen deprivation like bone loss. Local vaginal estrogen applied to the vulva or vagina to treat vaginal dryness, painful sex and bladder symptoms like urgency or recurrent urinary tract infections is another form of MHT.

Therefore, the correct terminology when referring to hormones that are given post menopause is either MHT (Menopausal Hormone Therapy) or HT (Hormone Therapy)

If you hear me use the term HRT, I am generally referring to Husband Replacement Therapy, which can be extremely useful post menopause, but it is not the same thing.

MHT is significantly lower than the estrogen and progestogen (synthetic progesterones) supplied in birth control pills. That makes sense.

Birth control pills are intended to suppress and replace ovarian function. Birth control pills say to the ovaries, “You take a vacation; we’ll take it from here.”

MHT is meant to supply a small amount of estrogen to make up for the fact that the ovaries are out of business.

In the graphic below, the blue (estrogen) and purple (progesterone) lines represent what occurs naturally.

• Pre-menopause- estrogen and progesterone are naturally high.

• Post menopause-estrogen and progesterone are zero.

• Birth control pills -estrogen and progestogen are higher than what a typical pre-menopause or perimenopause woman makes on her own.

• Menopausal Hormone Therapy estrogen and progestogen is much lower than birth control pills, but higher than natural post menopause levels.

When I tell women it is time to stop their birth control pills (generally around age 55) and switch over to MHT, they typically object under the misconception that birth control pills are “low dose” and MHT is “high dose” and dangerous. It’s the exact opposite.

Hormone therapy needs a PR firm to reverse the overall feeling that post menopause estrogen therapy is poison. And they should start by letting people know that we are not “replacing’ your hormones; we are giving you tiny doses to help your estrogen-starved body feel better and do better.

So next time someone asks you if you would like to take HRT, smile and say, “No, I like my husband- I think I’ll hang on to him. ”