Hormone Therapy, Estrogen Therapy and Menopause

For many years, hormone therapy was the gold standard treatment for menopause symptoms. Hormone therapy was also touted for its supposed health benefits, most notably; it was thought to protect women's hearts.

However, a landmark study called the Women's Health Initiative showed hormone therapy did not protect women's hearts. In fact, long term use of hormone therapy (estrogen-only as well as estrogen-progestin combined) slightly increased the risk of heart attack, stroke and blood clots in older women. While the increased risk was not huge, it was a dramatic shift in thought from hormone therapy as "protective."

Since that initial landmark study, additional study results have shown combined hormone therapy (estrogen and progestin) increases the risk of breast cancer in postmenopausal women with a uterus. Women at low risk of breast cancer who took estrogen alone had more abnormal mammograms but not an increase in breast cancer.

On the plus side, hormone therapy (combined and estrogen-alone) reduces the risk of colon cancer and helps protects bones against osteoporosis. Women who took hormone therapy had fewer bone fractures than women who did not take hormone therapy. Plus, it's still the most effective treatment available for certain menopause symptoms.

The bottom line from this large study is that the risks of hormone therapy generally outweigh the benefits for most women. But studies on the relationship between estrogen, progestin and their effects on the heart are on-going and each woman should weigh the risks and benefits based on their own health. Newer studies may find different results for younger women (50 to 59) who take hormone therapy.

What are the current recommendations?
When hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible.

Short-term, low-dose hormone replacement therapy may be an option for you if you have:

• Hot flashes
• Vaginal discomfort
• Risk for osteoporosis (if other medications to prevent osteoporosis can't be used)

Hormone therapy should never be used to prevent heart disease.

Pros of hormone therapy	Cons of hormone thereapy
Effectively manages certain bothersome menopause symptoms.	Does not protect against heart disease.
Helps protect against osteoporosis.	Slightly increases the risk of heart attack, strokes, blood clots and, in some women, breast cancer.
May reduce the risk of colon cancer.	Does not protect against Alzheimer's Disease or dementia and may actually increase the risk.

The final choice about whether to take hormone therapy depends on your menopause symptoms and your risks for other conditions. Weigh the pros and cons with your doctor to make the best decision for you.

Related Articles Understanding Menopause Symptoms of Perimenopause All About HRT and ERT Menopause Center Prescription Choices for Menopause Complementary and Alternative Treatments for Menopause Heart Disease and Menopause

External Sources National Institute of Health, National Heart Lung and Blood Institute, Women's Health Initiative. Accessed August 10, 2007. The Women's Health Initiative Participant Website. Accessed August 10, 2007.

This article was reviewed and updated June 2007.

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