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Hormone therapy: Is it right for you?

Until 2002, hormone therapy was routinely used to treat menopausal symptoms and protect long-term health. Then a large clinical trial unearthed its health risks. What does this mean to you?

By Mayo Clinic staff

During menopause, your ovaries decrease production of the female hormones estrogen and progesterone. This decline in hormones puts a permanent end to menstruation and fertility, but it can also cause hot flashes, mood swings, vaginal dryness and urinary problems. The solution? For decades, doctors routinely eased these symptoms with hormone replacement therapy — medications containing female hormones to replace the ones the body is no longer making. And it was widely believed that boosting estrogen levels after menopause could also ward off heart disease and osteoporosis, while improving quality of life and keeping women young.

Then, in 2002, a large clinical trial called the Women's Health Initiative (WHI) reported that hormone therapy actually posed more health risks than benefits for women in the clinical trial. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And up to two-thirds of women on the therapy discontinued its use, often without talking to their doctors.

Today, there's plenty of confusion about hormone replacement therapy, which is now commonly called hormone therapy. The truth is that hormone therapy is not the magical cure for aging that it was once believed to be, but it's still the most effective treatment for unpleasant menopausal symptoms for most women. If you're facing menopause, learn more about the benefits and the risks of hormone therapy.

What are the benefits of hormone therapy?

Estrogen remains the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.

Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:

  • Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
  • Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.
  • Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won't be completed for several years.

For women who undergo menopause naturally, estrogen is typically prescribed as part of a combination therapy of estrogen and progestin. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.

What are the risks of hormone therapy?

The Women's Health Initiative found that women taking the combination estrogen-progestin (Prempro) used in the study had an increased risk of developing certain serious conditions. According to the study, over one year, 10,000 women taking estrogen plus progestin compared with a placebo might experience:

  • Seven more cases of heart disease
  • Eight more cases of breast cancer
  • Eight more cases of stroke
  • 18 more cases of blood clots

Based on these numbers, the increased risk of disease to an individual woman is small. However, the overall risk to menopausal women as a group became a substantial public health concern. In addition, researchers found that women taking combination estrogen-progestin had an increase in abnormal mammograms. The higher number of false-positives — signs of possible breast cancer that ultimately prove inaccurate — was probably due to estrogen, which increases breast tissue density.

For women taking estrogen alone (Premarin), the WHI found no increased risk of breast cancer or heart disease. But researchers did find that over one year, 10,000 women taking estrogen compared with a placebo might experience 12 more cases of stroke and six more cases of blood clots in the legs, plus an increase in mammography abnormalities. This last point is important, because women who take estrogen or combination estrogen-progestin therapy may need more frequent mammograms and additional testing.

Who should consider hormone therapy?

Despite the inherent health risks, estrogen is still the gold standard for treating menopausal symptoms. For women who experience moderate to severe hot flashes or other menopausal symptoms, the benefits of short-term therapy outweigh the potential risks.

Data surrounding hormone replacement therapy can be scary and confusing. But the absolute risk to an individual woman taking hormone therapy is quite low — possibly low enough to be acceptable to you, depending on your symptoms. Talk with your doctor about your personal risks.

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Feb. 19, 2008

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