The Hormone Dilemma
The latest flip-flop on hormone therapy gives new hope to younger women
Relief. The key benefit of hormones is the relief they bring to women going through menopause who suffer insomnia, vaginal dryness, or hot flashes, which typically last three to five years. "For those of us who haven't had a hot flash, it sounds like some nice, warm, fuzzy feeling," says Taylor. "But it can be much more devastating than it sounds." Most women going through menopause suffer from hot flashes, and about 10 percent suffer flashes severe enough to disrupt their lives.
There may also be side benefits of hormones. In addition to the possible heart protection, women taking hormones in the WHI studies suffered fewer hip fractures and less colorectal cancer. Meanwhile, another new study from the University of Illinois shows that hormones used for fewer than 10 years can improve your mental performance. However, hormones used for longer than 10 years can actually harm mental acumen. "With memory and cognitive issues, there may be a similar 'window of opportunity' related to age and time since menopause," says Manson, although she stresses that this theory remains unproved and requires further research.
And, of course, hormones help you look younger. While any woman who is taking hormones could attest to this, science now supports it, too. A 2005 article published in the journal Fertility and Sterility, coauthored by Taylor, showed that women on long-term hormone therapy had fewer wrinkles.
To say the least, whether or not to take hormones is a tough decision. The risk varies depending on how old you are, how close you are to menopause, and whether or not you're already at risk for cancer or heart disease. It also depends on the type of hormone and how you take it. "It's very important to go over the risks that we know about hormones with your doctor," says Margery Gass, professor of obstetrics and gynecology at the University of Cincinnati.
When assessing the risks, it's important to look behind the numbers. For example, in the WHI estrogen-alone trial, even though estrogen boosted the risk of stroke by 39 percent for all age groups, that translates into just 12 additional cases per year per 10,000 women. Younger women fared much better than older women. Women ages 50 to 59 taking hormones did not experience more strokes than those in the placebo group, while women ages 60 to 69 taking estrogen experienced 19 additional strokes a year per 10,000 women.
"Catch-22." The same trial also showed an overall 33 percent increase in venous thromboembolic disease (blood clots in the leg veins or heart), which translated into 7 additional cases a year per 10,000 women. But again, the risks were lower for younger women, as they experienced two extra blood clots per 10,000 women per year, compared with 12 extra cases among women in their 70s.
For women taking estrogen with progestin, the risks are a little different. The risk of breast cancer is 26 percent higher, or 8 additional cases per year per 10,000 women taking hormones. (The women on estrogen alone, however, did not show an increase in breast cancer.) The risk for stroke grew 41 percent (8 additional cases per 10,000 women), and the risk for embolism more than doubled (also 8 additional cases per 10,000).
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