Posted by Brigham and Women's Hospital October 9, 2013
If you’re a woman nearing or beginning menopause, you probably have questions about whether to use hormone replacement therapy for relief of menopause symptoms such as hot flashes or night sweats. Recent findings from the Women’s Health Initiative (WHI), published in October 2013, may help you and your doctor evaluate the benefits and risk of hormone therapy in the context of your own health history.
Researchers analyzed more than 27,000 postmenopausal women, ages 50-79, in two hormone therapy trials (estrogen plus progestin and estrogen alone) over a 13 year period. They concluded that hormone therapy is helpful in managing the symptoms of menopause (such as hot flashes or night sweats) in younger women (ages 50-59); however, they cautioned against the use of hormone therapy to prevent chronic diseases, particularly in older women, due to an increased risk of adverse events.
Among women in the 50 to 59 year age group, researchers found that fewer than 1 in 100 had adverse events during five years of hormone therapy use, while the risk of adverse events were four to five times higher among the older women. Furthermore, because younger women were more likely to experience menopausal symptoms that were relieved by hormone therapy, the quality-of-life benefits outweighed the risks of adverse events in these women.
“It is important to distinguish between the use of hormone therapy for symptom management and its use for the purpose of chronic disease prevention. Short-term use of hormone therapy to manage moderate-to-severe hot flashes or other symptoms in early menopause remains appropriate,” said Dr. JoAnn Manson, who is first author of the report, Chief of Preventive Medicine at Brigham and Women’s Hospital (BWH), and one of the principal investigators of the WHI.
Researchers also compared the health risks and benefits of the two types of hormone therapy (estrogen plus progestin or estrogen alone) and found the following differences:
- Breast cancer risk was lower in women who received estrogen alone after a hysterectomy, compared to women with an intact uterus who received estrogen plus progestin.
- Both forms of hormone therapy increased the risk of stroke, blood clots in the legs, gallstones and urinary incontinence.
- A lower risk of bone fractures, diabetes and hot flashes and night sweats was seen with both types of hormone therapy.
- Estrogen plus progestin increased dementia in women ages 65 years and older, but neither treatment affected cognition or thinking abilities in the younger age group.
- For estrogen alone, younger women had lower rates of overall mortality, heart attacks, colorectal cancer, and combined chronic disease. Overall the risk to benefit ratio of estrogen alone was more favorable for younger women than for older women.
- Overall hormone therapy appeared to improve sleep and reduce joint pain but it also increased breast tenderness.
- Most risks and benefits of hormone therapy stopped once hormone therapy was discontinued; however, in women who had received estrogen plus progestin, researchers observed a slightly higher risk of breast cancer and a significantly lower risk of uterine (endometrial) cancer during the 13 year follow up period.
“Although studies of other hormone therapy formulations, doses and routes of delivery are still needed to find treatments with fewer risks, these medications are now among the best studied treatments in medical history. Clinicians can share information from the WHI trials with their patients and help them make more informed choices,” said Dr. Manson.
You can read more about the WHI findings at The Journal of the American Medical Association.
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Tom L./ Jamie R.