I think I’ve had this question on my mind a lot going through my nursing education. (This and what actually causes insulin resistance. (why does my body work so hard to keep fat)). I think it’s one advantage of being in middle age going through nursing school. I did find an article that brings together most of the conclusions I’ve reached about quality of life vs. length of life.
Bone density: This was the first issue that came up in Human Physiology. Loss of estrogen can be devastating to bone density. While HRT is one path, so is weight bearing exercise and balanced supplementation. (Calcium and Iron compete for absorption, so this is a whole other kettle of fish, and the alterations to Iron that accompany menopause could also be a factor.) But mostly, I’d say exercise and not Vitamin D supplementation would be the way to go.
Dysparenuria: (pelvic organ atrophy) Here again there are exercises that can be done and topical remedies, or even topical hormone placement. What confuses me is why steady state hormone replacement is the standard of care, when natural fertility has high estrogen only 25% of the time. Maybe combination therapies are different, and I suspect bioidentical hormones might try to mimic “natural” fertility. But, yeah, I’m not quite that in harmony with my body as it is.
Vasomotor symptoms: (hot flashes) I haven’t experienced these yet. So maybe I don’t appreciate the temptation to increase risks of various cancers and embolism to dispense with them. I guess we’ll have to see.
The risks: The main thing I have learned, that I am concerned most people won’t know, is the Women’s Health Initiative seems to suggest that estrogen only therapy is superior to combination. I’ve seen this concluded by doctors and in nursing textbooks, and it’s the frightening product of secondary research (review articles) which can lose the fact that the estrogen only cohort lacked uteruses. The reason combination therapy was developed is that estrogen alone makes the uterus grow unchecked, making excellent conditions for cancer.
So my current plan is not to mess with mother nature except with strength training.
The article that I feel has a good grasp on many of the issues is Scheider 2013 HRT in the Journal of Nursing Practice, “Hormone Replacement Therapy for Menopause.” Like that author (who is a man) I have to defer to the lived experience of people who have actually undergone menopause, but I’ll be 48 soon and my consideration of these questions is more than academic. Just in my case, as a mother with disabled children, I feel a lot stronger about not dying than I think some folks who could be satisfied to live a happier life if it’s shorter.