Though long-term hormone replacement therapy has serious health risks, going
off the medication may lead to a return of menopausal symptoms and increased
risk for high blood pressure, according to a new study.
Taking estrogens or estrogens and progesterone hormones can help alleviate
some bothersome symptoms of menopause, like hot flashes, vaginal dryness and
trouble sleeping, but the United States Preventive Services Task Force
recommends that postmenopausal women avoid the therapy due to an increased risk
of heart disease, stroke, dementia and breast cancer.
The risks were widely publicised after the Women's Health Initiative (WHI)
study results were published in 2002.
Despite those risks, "for some women there may be definite benefits (of
hormone therapy) that have not been realised," said lead author Dr Michelle
Warren of Columbia University Medical Center in New York.
The new study, which was funded by Pfizer, manufacturer of Prempro and
Premarin hormone replacement drugs, included 310 postmenopausal women aged 56 to
73 who had been on hormone therapy for at least five years.
The women were divided into three groups: those on continuous hormone
therapy, those who stopped taking the hormones briefly and went back on them and
women who stopped taking the hormones permanently.
About 16% of women taking hormones were also taking blood pressure medication
compared to 24% of women who had stopped for good, which suggests the hormones
may have a protective effect against high blood pressure.
That's one of the potential unknown benefits of the therapy, which can be
"quite safe" for women under 60 years of age who only take the hormones for two
to five years, Warren said.
Her study mainly included women at healthy weights with few other risk
factors, who are likely to experience the most benefits, she said.
Another potential benefit of staying on hormone therapy is better work
performance. For some women, severe menopause symptoms return after hormone
therapy is stopped.
Previous studies have found menopause symptoms associated with decreased work
ability and more sickness absences from work.
Quality of life
In this study, women taking hormones were about 20% more likely to be
employed and scored higher on a quality of life scale, according to results
published in the journal Menopause.
"The quality of life issue has not been well addressed but it's a big issue,"
For a small number of women, menopause can come with severe mood problems and
sleep disruption that can end relationships or careers, and non-hormonal options
aren't enough, she said.
Hormonal therapies usually cost between $10 and $85 per month without
insurance."Women stopped hormones in droves (after the WHI), but 1 out of 4
restarted," because they were having severe symptoms affecting quality of life,
said Dr JoAnn Pinkerton, medical director of the Midlife Health Center at the
University of Virginia in Charlottesville.
Pinkerton was not surprised by the results of the new study, but said she
will add in the potential connection to blood pressure to her discussions with
patients and figuring out what path is best for each individual patient, she
Some doctors stopped prescribing hormone therapy altogether after the WHI,
making it hard for some women to deal with their severe symptoms, Warren
Pinkerton suggests women with bothersome symptoms sit down with a menopause
specialist and discuss the safest options, which include lower doses of
estrogens delivered by a gel, patch or cream, and lower or intermittent doses of
What's right for one woman may not be best for another, she said."Just as the
decision to go on hormones is dependent on many factors, the decision to go off
and stay off can be individualised," Pinkerton said.
(Photo of mature woman from Shutterstock)