Hormone Replacement Therapy: Safe or Not?10/24/12
WEDNESDAY, Oct. 24 (HealthDay News) -- Is hormone replacement
therapy safe or not?
It has taken a decade of research to arrive at a conclusion that
is far from definitive: The evidence suggests it may help in the
short term to manage hot flashes and other symptoms of menopause in
some younger, healthy women. But, taking it for long periods of
time or later in menopause to help prevent certain chronic diseases
On Monday, the U.S. Preventive Services Task Force once again
backed the idea that long-term use later in menopause is unwise
when it released recommendations that said the increased health
risks outweighed the benefits of using the treatment in that
That was not always the prevailing view in the medical
For years, it was common for women suffering from hot flashes,
night sweats and other life-disrupting symptoms of menopause to go
on hormone replacement therapy -- typically a combination of
estrogen and progesterone or progestin (a progesterone-like
medication). That all changed in 2002, when the practice was halted
by many after the landmark Women's Health Initiative trial found
that rates for breast cancer and stroke were higher in women on
hormone replacement therapy compared to women who weren't taking
Although the study of more than 16,000 women reported some
benefits, including lower rates of hip fractures and fewer cases of
colon cancer, there were increases in heart disease, strokes and
pulmonary embolisms (dangerous blood clots in the lungs) in women
who took estrogen and progestin compared to women on placebo pills.
The study, scheduled to run until 2005, was shut down early as a
"After 2002 and the Women's Health Initiative study, people just stopped their hormone therapy. I think the study was an amazing study and gave us really good information, but you have to look at it in the time it was organized and developed, in early 2002, 2003," said Dr. Anne Ford, associate professor of obstetrics and gynecology at Duke University School of Medicine.
Hormone replacement therapy formulations have since changed, and
more recent research has teased out some groups of women who might
benefit from the treatment, she added.
A Danish study of 1,000 women published earlier this month in
BMJsuggested that women who began taking hormone replacement
therapy early in menopause and who continued taking it for an
average of 10 years cut their risk of having a heart attack, heart
failure or dying without raising their risk for breast cancer or
Two other recent reports also suggested that hormone replacement
therapy holds benefits for some. One found that it was safe for the
heart, and the other reported that it did not worsen memory in
"The new studies are well done and very important, since they address younger women," said Dr. Judi Chervenak, a reproductive endocrinologist at Montefiore Medical Center in New York City.
Although the newer research does not necessarily negate the
findings of the Women's Health Initiative study, she said, it also
does not have the power of that study in terms of how many women
were followed. She said the new studies support that for some women
-- especially younger women without any health problems -- hormone
therapy might be a good option.
"Hormone therapy is no longer the arsenic it was once thought to be after the Women's Health Initiative," Chervenak said. A woman suffering from hot flashes, vaginal dryness or osteoporosis should discuss the pros and cons with her doctor, she said.
"They need to talk about family history of heart disease, blood clots and high cholesterol," she explained. "For someone with very high triglycerides, for example, estrogen could adversely affect those levels."
There are two issues at play, said Dr. Margery Gass, executive
director of the North American Menopause Society.
"I want to get across the difference between taking something long term for prevention versus taking it short term when you're younger and healthier to treat symptoms for a limited amount of time," Gass said. "We recommend [hormone replacement therapy] as a viable option for treating menopausal symptoms in healthy women -- in women not at high risk for blood clots, breast cancer and stroke."
Gass said the newer research suggests that women should not be
taking hormone therapy to prevent chronic diseases associated with
That conclusion mirrors the latest opinion issued by the U.S.
Preventive Services Task Force, an independent panel of experts in
prevention and evidence-based medicine that makes screening
recommendations for various conditions and diseases.
The panel's review of 51 articles published since 2002
recommended that postmenopausal women, including those who have had
a hysterectomy, not take estrogen alone to prevent chronic
The potential harms of hormone replacement therapy outweigh any
possible disease-prevention benefits in these women, the task force
For women seeking non-drug options to manage the discomforts of
menopause, Ford suggested exercise, such as yoga, and a healthy
diet. Other strategies: Layer clothing, meditate, practice paced
breathing (also called relaxation breathing), maintain a healthy
weight and avoid smoking.
Ford said there is probably a lot to be learned by looking at
different communities and cultures, too. "Ethnicity seems to play a
role in how women manage menopause," she noted.
Earlier research has shown that black and Hispanic women tend to
enter menopause earlier than white women, and also tend to suffer
more severe symptoms.
For more on hormone replacement therapy, go to the
U.S. National Library of Medicine.
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