A candid conversation about MHT and risk
And how risk can be used to manipulate you - ugh!
Welcome to the sixth post in my series on menopause hormone therapy. So far we’ve covered MHT from nearly every angle I can think of (as a non-medical person who may be facing my own decision about MHT in coming years) and in this second-to-last post I wanted to have a candid conversation about risk.
Why? Because risk is really difficult to understand and to communicate, and the numbers can be presented in ways that can either reassure or create fear.
I can guarantee - because I’ve seen it - that people from all sides of the MHT debate will manipulate risk to convince you that a) using MHT is bad for you, b) not using MHT is bad for you, or c) using anything but “bioidentical” compounded hormones is bad for you.
When you can better understand risk, you can cut through the fear-mongering and make a more informed decision about what’s right for you and your unique situation.
Let’s get started with an example:
There are approximately 9 million postmenopausal women currently using oral MHT.
The increased risk of developing a blood clot on oral MHT is between 5-15 women for every 10,000 women on oral MHT, per year, depending on age. Let’s split that number down the middle and say that oral MHT causes blood clots in 10 out of every 10,000 women per year.
There are several ways to accurately present that data. Let’s look at how your brain responds to a few of them.
It’s accurate to say that the risk of developing a blood clot due to oral MHT is 0.1% which makes the risk feel miniscule.
It is also accurate to zoom out and look at the risk based on the entire population of women taking oral MHT in which case we can say that 9000 women will develop blood clots per year from MHT.
The risk of developing a blood clot from oral MHT is both 0.1% per year and 9000 women per year. Do you see how problematic this is in terms of understanding risk? One number feels tiny and reassuring and the other feels enormous and scary and yet they are both true.
But how does that risk compare to the normal, everyday risk of getting a blood clot? The baseline risk for getting a blood clot for women in their forties is approximately 5 women for every 10,000 women. So it’s accurate to say that taking oral MHT doubles your risk of getting a blood clot which again, sounds scary. But when doubling your risk takes your chance of developing a blood clot from 0.05% to 0.1%, it feels like the risk is still quite minimal, which is reassuring.
Another way in which determining risk is difficult, is that we take such a broad population-level view that it’s hard to understand what this means on an individual level. Do your genetics and lifestyle make you more or less predisposed to developing blood clots? What is your individual level of risk? If you never develop a blood clot from MHT, it turns out your risk was 0%. But if you do, it's 100%.
Ugh! Determining risk is hard, right?
One final consideration about risk: make sure you also weigh the risks of not taking MHT.
If your symptoms are severe and your sleep is continually disrupted due to night sweats, your risk of heart attack, diabetes, obesity, depression, and stroke all increase. Not to mention the impact that severe symptoms may have on your relationships, work, and overall quality of life - which is, admittedly, much harder to quantify in terms of absolute risk but important to consider nonetheless. Getting clear on the health risks from taking MHT and from not taking MHT in the context of your particular circumstances can help make a decision easier.
There are so many other things we could cover on this topic, but I think you’ve got the gist of it.
Ultimately, what I’d love for you to understand is this: there are few things in life that offer benefit without at least some level of risk. Learning how risk can be used to manipulate your feelings and decisions is an important life skill not just for thinking about menopause hormone therapy, but for interpreting headlines and (mis)information shared and re-shared on social media.
xo, Rebecca
P.S. Niche, but funny.