The Latest Wisdom on Hormone Therapy
What do we know now about hormones and the heart?
When the WHI data on heart risk was analyzed according to age and the number of years since menopause, it suggested that there's no additional risk of heart attack among women in their 50s who are on HT. But it seems that the further a woman gets from menopause, the greater the odds that hormones will hurt her heart. "That's very important for younger women who want to use hormones for short-term treatment of menopausal symptoms," says Jacques Rossouw, a researcher for the National Heart, Lung, and Blood Institute and an author of the study, which appeared in the Journal of the American Medical Association. "It's a reasonable option if they're within 10 years of menopause. Further than that, think long and hard about using them."
Are all hormones the same?
No, but it's still unclear exactly how they differ. These studies are referring to combined therapy–estrogen plus progesterone. Short-term use of estrogen alone doesn't seem to boost the risk of breast cancer, for reasons that are not understood. It does carry an additional risk of uterine cancer and isn't used in women who still have a uterus. Both estrogen alone and the combined therapy increased the risk of the heart problems and stroke. The new ovarian cancer study didn't find that risk varied by type of HT.
How does age factor in?
The heart study showed that the younger, the better, when it comes to taking HT. That may be true for cancer, too, says Ravdin. Since the disease already strikes older women more than younger, adding HT to the mix may multiply the risk of problems.
So what's the bottom line?
The basic advice hasn't changed: HT may be prescribed in the short term to relieve symptoms, but beyond a few years–and the further you are from menopause–the greater the risk. Talk to your doctor about how your individual risk balances out the potential benefits of HT. Those individual risks may include family history of cardiac disease and breast cancer as well as a history of clots while using oral contraceptives, both of which may signal a higher risk of heart problems, says Daly.
advertisement
