Hot flashes, sleepless nights, vaginal dryness, mood swings... The symptoms of menopause can be uncomfortable. Many treatment options are available, including controversial hormone therapy. But is it safe?
The North American Menopause Society (NAMS) and 14 other medical organizations say it is safe for some. The groups recently released a statement that supports hormone therapy for the treatment of menopause symptoms in younger postmenopausal women.
Still, 10 years ago, the Women’s Health Initiative (WHI) – a large-scale study of women and disease – warned against the harmful effects of hormone therapy and concluded that the risks outweigh the benefits.
The conflicting reports left many women confused about the safety of hormone therapy.
“Women and clinicians are frustrated… That’s why we [brought the medical organizations] together in agreement regarding the use of hormone therapy,” said Dr. Margery Gass, executive director for NAMS, in a statement.
The risks of hormone therapy made headlines in 2002, when the WHI released its results from a 15-year study that examined the effects of hormone therapy, diet and other factors and their relationship to heart disease, breast and colorectal cancer and osteoporotic fractures in postmenopausal women.
The study’s hormone therapy trials looked at the effects of estrogen-progestin combined hormone therapy and estrogen-alone therapy. The study and its clinical trials involved more than 160,000 healthy postmenopausal women and used hormone pills and placebo pills.
Researchers found that combined hormone therapy increased a woman’s risk of cancer and heart disease. In fact, the team actually halted the study three years early because of their findings. After the study results were published, many women – and their doctors – discontinued use of hormone therapy.
Since then, follow-up data from the study shows which factors posed risks for women using hormone therapy, and it turns out the risks vary based on a woman’s medical history, age and the number of years she has been in menopause.
Researchers found that contrary to previous findings, use of estrogen-alone therapy (for an average of six years) in women who had a hysterectomy did not raise the risk of death, coronary heart disease, colorectal cancer, and hip fractures.
They also report that among women in their 50s, estrogen therapy decreased risk of heart disease and mortality, but increased the risk of these for women in their 70s.
Plus, they found that estrogen-only treatment decreased the risk of breast cancer for women regardless of age.
Despite the new information about hormone therapy’s potential benefits, many women continue to avoid hormone therapy.
“We believe that too many women are missing out on the proven benefits of hormone therapy because the results of the WHI, which studied the long-term use of hormones to prevent chronic disease, were misinterpreted for women with menopausal symptoms,” said Gass.
The organizations supporting hormone therapy’s benefits say in the joint statement that “hormone therapy is acceptable and relatively safe for healthy, symptomatic, recently postmenopausal women.”
They say hormone therapy is safe for women up to age 59 or within 10 years of menopause. Healthy women who have moderate to severe menopausal symptoms may also use hormone therapy, they note.
Hormone therapy’s risks
The medical groups that support use of hormone therapy agree that estrogen-alone therapy and estrogen with progestin therapy increases the risk for stroke and blood clots in the legs and lungs, although the risk is rare for women 50-59 years old. A woman’s risk of heart disease more than doubles within the first two years of taking combination therapy, says the National Institutes of Health.
The groups also agree that five or more years of continuous combined therapy increases the risk of breast cancer.
Hormone therapy’s benefits
The benefits of combined hormone therapy include reduced risk of hip fracture and reduced risk of colorectal cancer, according to the WHI study.
Estrogen-only therapy can reduce the risk of breast cancer.
Current recommendations
A woman’s medical history and personal characteristics should be considered when treating menopausal symptoms.
Doctors can help patients determine whether or not they are good candidates for hormone therapy and what type of hormone therapy will provide them the greatest relief at the lowest risk, said Dr. Robert Lobo, past president of the American Society for Reproductive Medicine, one of the groups that issued the statement.
The current consensus is that women age 60 and over should not use hormone therapy because it will not prevent heart disease when started several years after menopause. In fact, it can increase risk for certain diseases.
Hormone therapy may also be used to treat severe symptoms.
“I recommend it to [menopausal] women with intolerable symptoms who understand the small but real risks,” says Robert Carlson, MD, a primary care physician and dailyRx medical expert.
Younger menopausal women who still have a uterus should take a progestin along with the estrogen to prevent uterine cancer, the medical groups say in the joint statement. They recommend that menopausal women who have had a hysterectomy take estrogen alone.
Lastly, the groups recommend low doses of vaginal estrogen to women who suffer only from vaginal dryness or discomfort during intercourse.
Other treatment options
Other types of medication can help relieve symptoms.
Low-dose oral contraceptives can reduce symptoms for women in perimenopause, or the years preceding menstruation’s end.
Over-the-counter drugs, such as K-Y Jelly, can treat vaginal discomfort. For more severe cases, an estrogen patch worn on the lower stomach or estrogen creams, tablets and rings placed in the vagina may be prescribed.
Medications prescribed for other conditions – including epilepsy, depression and high blood pressure - can help fight hot flashes and moodiness.
Alternative therapies might also offer relief. Some studies show that yoga, acupuncture and meditation-based exercises such as tai chi and qi gong can reduce the frequency and intensity of hot flashes, improve sleep, and reduce stress, mood disturbances and muscle and joint pain.
The other organizations supporting the benefits of hormone therapy in the statement include the American Society for Reproductive Medicine (ASRM), Endocrine Society, Academy of Women’s Health, American Academy of Family Physicians, American Academy of Physician Assistants, American Association of Clinical Endocrinologists, American Medical Women’s Association, Asociacion Mexicana para el Estudio del Climaterio, Association of Reproductive Health Professionals, National Association of Nurse Practitioners in Women’s Health, National Osteoporosis Foundation, Society for the Study of Reproduction, Society of Obstetricians & Gynaecologists of Canada, and the SIGMA Canadian Menopause Society.
