Hormone Therapy Is Safe for Treating Menopause

A 20-year follow-up on the most extensive study on postmenopausal women’s health shows that the benefits of hormone therapy outweigh possible risks for most women.

The findings of the Women’s Health Initiative (WHI), a large study focusing on disease prevention in postmenopausal women, published in 2002, highlighted the side effects of taking combination hormone therapy for menopause symptoms.

The use of estrogen and progestin was then found to increase the risk of breast cancer, heart disease, stroke, blood clots, and urinary incontinence. Although women using combined hormone therapy were less likely to experience fractures and develop colorectal cancer, these benefits did not outweigh the risks, the study concluded.

As a result, many women discontinued hormone therapy, which led to a sharp decline in breast cancer rates in 2003.

However, the findings of the 20-year follow-up, published in JAMA Women’s Health, paint a different picture. The study discovered that women below the age of 60 had lower rates of adverse events and a more favorable benefit-to-risk ratio of hormone therapy than women in later menopause.

The findings support the use of hormone therapy in early menopause for the treatment of moderate-to-severe hot flashes, night sweats, and other menopausal symptoms, an indication approved by the U.S. Food and Drug Administration.

Hormone therapy should not be used to prevent heart disease, stroke, dementia, or other chronic diseases.

“The WHI findings should never be used as a reason to deny hormone therapy to women in early menopause with bothersome menopausal symptoms. Many women are good candidates for treatment and, in shared decision-making with their clinicians, should be able to receive appropriate and personalized healthcare for their needs,” JoAnn Manson, M.D., Chief of Preventive Medicine at Brigham and Women’s Hospital and first author of the study, said in a statement.

The study found that hormone therapy didn’t increase mortality rates across age groups compared to a placebo. Nor did it significantly raise heart and stroke risk.

Breast cancer risk increased with prolonged use of combination hormone therapy. Women who took estrogen alone, as a result of having undergone a hysterectomy, had a 20% lower risk of developing breast cancer.

More than one million women in the United States experience menopause each year. The symptoms can be debilitating and usually last about seven years, having profound effects on the quality of life.

Not only does menopause increase the risk of multiple diseases, but it can also put personal relationships under immense strain. Moreover, menopause can have a devastating impact on professional life. Ninety-nine percent of women reported their perimenopausal or menopausal symptoms leading to a negative impact on their careers, according to a survey in the United Kingdom.

Menopause supplements are beneficial for some

The study also examined the effects of calcium and vitamin D supplementation, as well as a low-fat dietary pattern among postmenopausal women.

Half of postmenopausal women develop osteoporosis, a disease that weakens bones by making them thinner and less dense, and most will experience fractures.

The new findings do not support routinely recommending calcium and vitamin D supplements for fracture prevention in all postmenopausal women. However, these supplements may help fill nutritional gaps for women who do not meet national guidelines for intake of these nutrients through diet.

Following a low-fat dietary pattern with a higher intake of fruit, vegetables, and grains did not reduce the risk of breast or colorectal cancer. Still, it was associated with a lower risk of breast cancer mortality.

What is hormone therapy?

Hormone therapy focuses on replacing estrogen, the hormone no longer produced after menopause. Estrogen plays a key role in reproductive health and affects the heart and blood vessels, bones, skin, hair, and the brain, among others. There are two main types of hormone therapy:

  • Systemic hormone therapy involves a higher dose of estrogen, which comes in the form of a pill, skin patch, ring, gel, and other products. This type of therapy targets any of the common symptoms of menopause.
  • Low-dose vaginal products, such as creams, tablets, or rings, are typically used to treat the vaginal and urinary symptoms of menopause.

Hormone therapy is unavailable for some people — it is normally not prescribed for individuals with breast and other hormone-sensitive cancers or a history of blood clots.

However, everyone can manage menopausal hot flashes by keeping cool, limiting their caffeine and alcohol intake, and practicing relaxation techniques, such as relaxed breathing.

Menopause can be long and debilitating; therefore, it is essential to explore treatment options with your healthcare provider.

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