Hormone Therapy Revisited

Treating menopausal symptoms short-term may not be as dangerous as you think

Once upon a time—and not that long ago—there was a clear solution to the hot flashes, night sweats and other troublesome symptoms of menopause: hormone replacement therapy. Women who’d had a hysterectomy received estrogen, and progestin was added for those with an intact uterus, since estrogen alone raises the risk for uterine cancer.

“We used to think every woman at this stage of life should be on hormone therapy,” says gynecologist Gary Conner, M.D., of Lehigh Valley Hospital and Health Network. The assumption was that hormone replacement not only relieved symptoms, it also protected older women from heart disease (as their own estrogen does in the child-bearing years) and possibly other conditions.

A major study—the Women’s Health Initiative—set out to prove that assumption. Instead, in 2002 the study released an alarming finding: Women on combination estrogen/ progestin (Prempro) faced an increased risk for heart attack, stroke, blood clots and breast cancer. Women in the study were told to stop taking their pills, and women all over the country hurriedly followed suit.

As it turns out, that mad rush to the trash can may not have been necessary, in part because of how the Women’s Health Initiative was structured. “The women in the study were 10-25 years past menopause when they began hormone therapy, and its effects are time-dependent,” Conner says. “If you begin hormone therapy as soon as you stop menstruating, it may provide some heart disease protection. But if you don’t begin until several years later, as the women in the study did, your heart disease risk may increase.”

The data from the Women’s Health Initiative is still being analyzed. Researchers recently announced that estrogen alone (Premarin) appears to be less risky than combined hormones when it comes to breast cancer and blood clots, though it’s more risky in terms of stroke.

So, is hormone therapy worth considering? “Not if your only goal is heart disease protection,” says cardiologist Deborah Sundlof, D.O., of Lehigh Valley Hospital and Health Network. “There are plenty of other proven ways to protect your heart, including a low-fat diet, regular exercise and quitting smoking.”

If your problem is menopausal symptoms, hormone therapy can be a big help, Conner says—but for the shortest time possible and at the smallest dose needed to ease the symptoms. Hormones can cause unpleasant side effects such as breast tenderness or swelling, fluid retention and spotty bleeding. Of course, that’s a small price to pay for women whose vaginal dryness or night sweats make them miserable.

“We usually suggest going on hormone therapy for a trial period, then coming in for re-evaluation,” Conner says. “If symptoms persist, we can adjust the dose.” Besides pills, hormones are now available as patches, creams and vaginal inserts. Products that target the hormones specifically where they’re needed deliver a lower overall dose to your body.

If you have a history of blood clots, cancer, heart disease, high blood pressure or certain other conditions, you’re probably not a candidate for hormone therapy.

What about alternative therapies? Some women do find symptom relief from the phytoestrogens (plant-based estrogens) in soy products, black cohosh and wild yam, Conner says. Talk to your doctor if you’re thinking of using an alternative therapy for menopausal symptoms.

Want to Know More about your body’s “hormone factory”? See right.

ARTICLE TOOLS: