Study Finds Hormones For Menopause Are Safe

A new study finds that the benefits of hormone therapy for treating menopause symptoms outweigh the risks. Menopause experts say it is time to revisit hormone replacement therapy (HRT), especially for women under the age of 60.

The study, published in early May on the JAMA Network, had markedly different results than the landmark Women’s Health Initiative (WHI) from 20 years ago. The older study sent shockwaves through the medical field, as the study is the largest women’s health prevention study ever conducted. The Washington Post reports:

The importance of the WHI and its impact on women’s health can’t be overstated. The study enrolled more than 160,000 postmenopausal women between the ages of 50 and 79. But in 2002, part of the study’s menopause hormone trial was abruptly stopped after monitoring data suggested that women in the hormone group had an increased risk of cardiovascular disease, stroke, pulmonary embolism and breast cancer.

After the results of that study, millions of women stopped taking hormone replacement therapy (HRT) and many doctors stopped prescribing it, leaving women to go through the symptoms of menopause alone.

Today, however, a long-term follow-up of the women in the WHI shows that “the drugs are a relatively safe option for the short-term treatment of menopause symptoms in women under 60. Hormones still aren’t recommended for long-term use to prevent heart attack, dementia or other chronic conditions.”

Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health in Jacksonville, tells the Washington Post, “There is still a substantial group of women still not using hormone therapy because they are fearful of its adverse effects. This should be reassuring to women under the age of 60 with bothersome symptoms.”

What was the problem with the old study?

First, Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells NPR, “Women should know that hormone therapy is safe and beneficial.”

She explains that in retrospect, the initial study was flawed in several ways. Issues with the study included:

• The type of progestin used was “highly problematic” and may have been linked to an increase in breast cancer.
• Most of the women in the study were over the age of 60. Streicher notes that the window for hormone therapy is typically between ages 50 and 60.
• Women in the study were taking estrogen orally, which could have increased the risk of pulmonary embolism.

The new study notes that there are a wide range of hormone therapies now available, and there is no one-size-fits-all solution for all women. Dr. Streicher notes, “Hormone therapy is beneficial way beyond the benefits to just helping with hot flashes.”

What are the findings from the new study?

Results from the long-term follow-up include:

• When compared with women of similar age taking a placebo, hormone therapy did not increase mortality rates in any age group.
• There was no significant difference in cardiac risk between hormone users and non-users.
• Stroke risk among younger users was low – less than one case per 1,000 women using estrogen-progestin therapy, and no excess risk from using estrogen alone.
• Women who used estrogen alone (allowed only for those who have had a hysterectomy) experienced a 20% reduction in breast cancer risk during the follow-up period.
• Breast cancer risk did increase with longer use of combination drugs, like estrogen and progestin. However, says JoAnn Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital and the paper’s first author, “Putting the risk into perspective, it’s the equivalent of the excess risk of breast cancer associated with drinking one to two alcoholic beverages daily.”
• Across all age groups, bone fracture risks among hormone users was 33% lower as compared to the placebo group.

The Washington Post notes, “The paper also stressed that women should not routinely take hormones to prevent heart disease, stroke, dementia or other chronic diseases, and that they don’t need calcium or vitamin D supplements unless they are nutritionally deficient in them.”

The study also recommends a diet low in fat and high in fruits, vegetables, and grains. This diet, however, does not appear to reduce the risk of breast or colorectal cancer.

Before the first study came out, almost 15 million women were receiving annual prescriptions for HRT therapy. This included for the prevention of heart disease, despite a lack of research. Using the drugs to prevent heart disease and dementia grew increasingly common.

Manson says, “It was important to put the brakes on that. But it was never intended for women to stop using it for bothersome hot flashes and night sweats. It’s important that women know there is this option.”

Your takeaways

Faubion tells the Washington Post that hormone therapy is the “most effective treatment” for women “significantly impacted” by menopause symptoms. Today, hormone drugs include a wide range of options, including lower-dose estrogen and estrogen delivered through the skin as a patch or gel. The transdermal approach means that the estrogen is not metabolized by the liver, which can increase the risk of blood clots.

There are also numerous non-hormonal treatments available to ease the symptoms of menopause.

Christine Kistler, associate professor of medicine in the geriatrics division of the University of Pittsburgh, says, “I love this review. It nicely demonstrates that HRT is relatively low risk in younger postmenopausal women when menopausal symptoms typically are worse and wane over time, though some women still have hot flashes well into their 60s.”

Finally, the study recommends that women talk to their doctors about the various options that may suit their needs.

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