Hormone Therapy Safe, Effective for Women Entering Menopause

HealthDay + More

By Serena Gordon
HealthDay Reporter

TUESDAY, May 20 (HealthDay News) -- Many women, and even some physicians, quickly abandoned the use of hormone replacement therapy in 2002, after the large Women's Health Study suggested that the treatment might harm women who were long past menopause.

But now a team of international experts has concluded that for women in early menopause, hormone replacement therapy (HRT) can safely provide real symptom relief, as well as additional benefits such as increased bone strength.

"Young healthy women at the onset of menopause shouldn't be afraid to use hormones," said Dr. Roger Lobo, a professor of obstetrics and gynecology at Columbia University in New York City, and one of the authors of the report on HRT and menopause submitted to the first International Menopause Society Global Summit on menopause-related issues.

"Women need to know that hormone therapy in early menopause is safe and is absolutely the most effective way of managing the menopausal transition," said Dr. Melissa McNeil, chief of the section of women's health at the University of Pittsburgh Medical Center and a professor of medicine, obstetrics and gynecology at the University of Pittsburgh School of Medicine.

Initial results were released from the Women's Health Study in 2002. Those findings suggested that HRT increased a user's risk of breast cancer and -- more surprisingly -- their risk of heart disease. Older women were immediately advised to stop taking hormones, and even women just entering menopause were advised against using hormone therapy.

However, what wasn't widely understood at the time was that the women in the study tended to be long past menopause -- often by at least 10 years -- when they started taking the hormones. Additionally, the summit experts pointed out that one-third of the women in the trial were obese, more than one-third had high blood pressure, and almost half were current or former smokers. All of these factors could raise the risk of heart disease on their own.

To assess the effects of HRT in younger women, more than 40 experts from all over the world reviewed available data on the safety and efficacy of hormone replacement therapy, paying particular attention to four key areas: cardiovascular health, breast issues, cognition and bone health.

Findings from this summit were expected to be presented Tuesday at the World Congress on the Menopause in Madrid, Spain. Some of the key findings included:

  • Combined estrogen and progesterone do not increase heart disease risk in women aged 50 to 59.
  • Estrogen therapy alone decreased the risk of heart disease in women between 50 and 59.
  • Hormone replacement therapy helps maintain bone health.
  • Cognition isn't impaired by the use of hormones between 50 and 59; hormone therapy may help prevent some cognitive decline in this age group.
  • Combined use of estrogen and progesterone may increase the risk of breast cancer after 5 years of use; estrogen-alone therapy appeared to bring no increase in risk of breast cancer after at least 7 years of use. The researchers felt the increase for breast cancer risk from hormone therapy was small, especially when compared to other risk factors, such as obesity.

Lobo said there are women who definitely shouldn't take HRT: those who already have heart disease, those who've had breast cancer, and women with a history of blood clots.

McNeil said she doesn't recommend HRT for women with multiple risk factors for heart disease, such as diabetes, high blood pressure, a strong family history, or smokers.

"A woman who's healthy and has symptoms, [such as hot flashes or vaginal dryness], going into menopause will reap some quality of life benefits from hormones," said Lobo, who added that the protective effects seen in bone health and in cardiovascular risk are additional benefits for women taking hormones for symptom relief.

"I don't think we'll ever prescribe hormones solely for heart disease, but it's a side benefit," he said.

"For the first five years of therapy, there's no increased risk of breast cancer and for the normal-risk patients, there's no increased risk of cardiovascular disease, so women can feel comfortable that their symptoms can be managed effectively," said McNeil.