Hormone Therapy Estrogen Therapy and Menopause

For many years, hormone therapy (HT) was the standard treatment for menopause symptoms such as hot flashes. It was also thought to have health benefits. Most notably, experts believed it helped prevent heart disease.

But a landmark study called the Women's Health Initiative showed that HT did not protect women's hearts. In fact, long-term use of hormone therapy (both estrogen-only and combined estrogen-progestin) slightly raised the risk of stroke and blood clots in older women. Combined therapy also raised the risk of heart attack. (The effect of estrogen-only therapy was not clear.) The increased risks were small, but they were enough to cause a dramatic shift in thinking about hormone therapy.

Since that first study, further research showed that combined HT raises the risk of breast cancer in postmenopausal women with a uterus. Women who took estrogen alone had more abnormal mammograms but no increase in breast cancer.

Here is a brief summary of the findings.

Pros of hormone therapy

• Reduces some bothersome menopause symptoms
• Helps protect against osteoporosis
• Lowers the risk of colon cancer

Cons of hormone therapy

• Does not protect against heart disease
• Slightly raises the risk of heart attack, strokes, blood clots and, in some women, breast cancer
• Does not protect against Alzheimer's disease or dementia and may actually increase the risk

The bottom line: The risks of hormone therapy outweigh the benefits for many women. Experts continue to study estrogen and progestin and their effects on the body. Until more is known, each woman should weigh the pros and cons of HT based on her personal health history.

What are the current recommendations?

Hormone therapy is still the most effective treatment for moderate to severe menopause symptoms. Your doctor might recommend it to:

• Decrease hot flashes, night sweats, vaginal dryness and other menopausal symptoms
• Prevent bone loss if you are not able to use other medications for this purpose

HT should be taken at the lowest dose and for the shortest time possible to relieve symptoms.

HT should not be used to prevent heart disease. Other medications and lifestyle changes offer better ways to prevent this.

The final choice about whether to take hormone therapy is up to you. Your doctor can help you weigh the severity of your menopause symptoms against your disease risks so you can make the best decision for you.