Posted by Brigham and Women's Hospital December 28, 2012
Many women experience bothersome symptoms during menopause, such as hot flashes, night sweats, and vaginal dryness. Hormone therapy (HT) can provide relief from the symptoms of menopause, but studies have shown that these benefits of HT may come with added risks, especially if hormone therapy is started more than 10 years after the onset of menopause. For example, in the Women’s Health Initiative (WHI), in which women were an average age of 63, the risks of combination estrogen plus progestin (stroke, heart attacks, venous blood clots, and breast cancer) outweighed the benefits. As a result, there was a sharp decrease in the number of women using HT, leaving them with few options for symptomatic relief.
Now a new study called KEEPS (Kronos Early Estrogen Prevention Study), finds that women can experience the benefits of HT while minimizing the health risks, provided therapy is given early in menopause and at low doses for up to four years. JoAnn Manson, Chief of Preventive Medicine at Brigham and Women’s Hospital, one of the KEEPS and WHI principal researchers, said “Many newly menopausal women will be using hormone therapy for only four to five years , so these findings will have great relevance to them.”
The study included 727 women ranging in age from 42 to 58. Some of the women were randomized to estrogen pills and others to estrogen patches, both combined with natural progesterone pills taken 12 days a month. They were compared with women using placebo patches and pills.
Women in the study reported improvements in the most bothersome and troublesome symptoms. They experienced improvements in hot flashes, night sweats and sexual function. Depression and anxiety symptoms were eased and there were no adverse effects on thinking abilities. These benefits persisted over the four years of the trial.
Just as importantly, researchers found that patients in the study had a low rate of adverse events and did not exhibit a decline on other important health measures. In some cases, they even saw improvements in health:
- No adverse effect on blood pressure, in contrast to the WHI
- No significant differences in the buildup of deposits in coronary or carotid arteries
- Increases in “good” cholesterol (HDL), which protects against heart disease, and decreases in “bad” cholesterol (LDL) with estrogen pills
- Improvements in bone density with both pills and patches
- Lowered insulin resistance with estrogen patches
While KEEPS shows promising results and offers reassurance for women who want symptomatic relief, experts agree that hormones should only be used in cases where women are suffering moderate to severe menopausal symptoms. KEEPS was not large enough to evaluate the safety of HT for clinical events such as heart attacks and strokes. Experts also recommend the lowest dose for the shortest amount of time necessary to meet treatment goals.
To learn more about hormone therapy listen to Dr. Manson’s podcast.
– Pamela S.