Hormone therapy may help some women manage hot flashes
during menopause. But it should not be used to prevent conditions like heart
disease and dementia, a new study confirms.
After analysing data from about 30 000 women, researchers
found the risk of serious health problems increased while women were taking hormones
as past studies have also shown and then fell once they went off the
pills. "The findings suggest that hormone therapy is a reasonable option
for short-term treatment of menopausal symptoms in early menopause but should
not be used for long-term chronic disease prevention," Dr JoAnn Manson,
the study's lead author from Brigham and Women's Hospital in Boston, told Reuters
The new report, published in the Journal of the American
Medical Association, looks at women who were part of the original Women's
Health Initiative studies. Those studies were large, randomised trials of
hormone therapy that were stopped early when it became clear that women taking
oestrogen alone or a combination of oestrogen and progesterone had higher rates
of ovarian cancer, breast cancer, strokes and other health problems.
For the new study, Manson and her colleagues analysed data
recorded during the trials and for six to eight years after women stopped
taking the hormones. Overall, 27 347 US women between the ages of 50 and 79
were included in the trials. Women were randomly picked to receive hormone
therapy, either oestrogen and progesterone or oestrogen alone or a placebo.
The trials lasted six to seven years before they were
stopped beginning in 2002. Women were then followed until 2010. During the
trial, the risks of taking oestrogen plus progesterone outweighed the benefits,
the researchers write. But many of those risks fell during follow up.
For example, they found hormone use could account for six
additional cases of heart disease per 10 000 women each year during the trial.
That dropped to two extra heart disease cases per 10 000 women every year after
women stopped taking hormones. Women who were assigned to oestrogen plus
progesterone continued to have an increased risk of breast cancer after
stopping hormone therapy, however.
Among women who took oestrogen alone who had all previously
had their uterus removed the risks and benefits were more balanced from the beginning.
During the trial, oestrogen alone was tied to about 11 extra strokes per 10 000
women per year.
That risk also fell once women stopped taking oestrogen.
However, women who only took oestrogen were less likely to develop breast cancer
over the entire study period than those in the placebo group.
Considering all the evidence, the researchers write that
oestrogen plus progesterone or oestrogen alone should not be used to prevent
Reasonable option for
That advice jibes with the government-backed US Preventive
Services Task Force's recommendation against taking hormone therapy for the
prevention of chronic disease. The researchers add, however, that hormone therapy is a
"reasonable option for the management of moderate to severe menopausal
symptoms among generally healthy women during early menopause."
Manson said probably fewer than one in 100 younger
women taking hormone therapy for menopausal symptoms over five years would
develop a health problem as a result. "For some women who are experiencing
the symptoms of menopause, the quality-of-life benefits may outweigh the
risks," Dr Betsy Nabel, president of Brigham and Women's Hospital, wrote
in an email to Reuters Health.
"Ultimately, every woman should discuss their
individual risk profile and the best way to manage their symptoms with their
care provider to decide what the best choice is for them," Nabel, who
wrote an editorial accompanying the new study, said.