Complications (2)
- Osteoporosis
- Menopause weight gain: Stop the middle age spread
Lifestyle and home remedies (4)
- Diabetes and menopause: A twin challenge
- Quit smoking: Proven strategies to help you quit
- Belly fat in women: Taking — and keeping — it off
- see all in Lifestyle and home remedies
Risk factors (1)
- Menopause weight gain: Stop the middle age spread
Symptoms (1)
- Vaginal atrophy
Treatments and drugs (2)
- Hormone replacement therapy and your heart
- Hormone therapy: Is it right for you?
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Hormone therapy: Is it right for you?
Until 2002, hormone therapy was routinely used to treat menopausal symptoms and protect long-term health. Then a large clinical trial unearthed its health risks. What does this mean to you?
By Mayo Clinic staffHormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy (as it's now called) was also thought to have the long-term benefits of preventing heart disease and osteoporosis.
Attitudes about hormone therapy changed abruptly in 2002, when a large clinical trial found that the treatment actually posed more health risks than benefits for postmenopausal women. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And most women on hormone therapy discontinued its use, often without talking to their doctors.
What are the benefits of hormone therapy?
Women who choose standard hormone therapy during natural (nonsurgical) menopause typically take estrogen and progestin, a man-made version of progesterone. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.
Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:
- Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
- Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.
- Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won't be completed for several years.
For women who undergo menopause naturally, estrogen is typically prescribed along with progestin, a man-made version of progesterone. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.
What are the risks of hormone therapy?
In the largest clinical trial to date, the combination estrogen-progestin (Prempro) increased the risk of certain serious conditions.
According to the study, over one year, 10,000 women taking estrogen plus progestin might experience:
- Seven more cases of heart disease than women taking a placebo
- Eight more cases of breast cancer than women taking a placebo
- Eight more cases of stroke than women taking a placebo
- Eighteen more cases of blood clots than women taking a placebo
- An increase in abnormal mammograms, particularly false positives
The study found no increased risk of breast cancer or heart disease among women taking estrogen without progestin. Over one year, however, 10,000 women taking estrogen alone might experience:
- Twelve more cases of stroke than women taking a placebo
- Six more cases of blood clots in the legs than women taking a placebo
- An increase in mammography abnormalities
The effect of hormone therapy on mammograms is important, because it suggests that women on hormone therapy may need more frequent mammograms and additional testing.
Who should consider hormone therapy?
Despite the health risks, estrogen is still the gold standard for treating menopausal symptoms. The absolute risk to an individual woman taking hormone therapy is quite low — possibly low enough to be acceptable to you, depending on your symptoms.
The benefits of short-term hormone therapy may outweigh the risks if you:
- Experience moderate to severe hot flashes or other menopausal symptoms
- Have lost bone mass and either aren't able to tolerate other treatments or aren't benefitting from other treatments
- Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure)
Women who experience premature menopause or premature ovarian failure have a different set of health risks compared with women who reach menopause near the average age of about 50, including:
- A lower risk of breast cancer
- A higher risk of osteoporosis
- A higher risk of coronary heart disease (CHD)
In addition, hormone therapy appears to reduce the risk of osteoporosis and CHD when started soon after menopause in young women. For women who reach menopause prematurely, the protective benefits of hormone therapy may outweigh the risks.
Talk with your doctor about your personal risks.
Next page(1 of 2)
- Martin KA. Postmenopausal hormone therapy: Benefits and risks. http://www.uptodate.com/home/index.html. Accessed Dec. 22, 2009.
- Menopause and hormones. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118624.htm. Accessed Dec. 22, 2009.
- Ferri FF. Hot flashes. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/175824536-4/931096584/2088/311.html#4-u1.0-B978-0-323-05609-0.00017-4--s3595_6411. Accessed Dec. 22, 2009.
- Martin KA. Treatment of menopausal symptoms with hormone therapy. http://www.uptodate.com/home/index.html. Accessed Dec. 22, 2009.
- Questions and answers about the WHI postmenopausal hormone therapy trials. National Institutes of Health. http://www.nhlbi.nih.gov/whi/whi_faq.htm. Accessed Dec. 22, 2009.
- Questions and answers about the estrogen-alone study. National Institutes of Health. http://www.nhlbi.nih.gov/whi/e-a_faq.htm. Accessed Dec. 22, 2009.
- Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society. Menopause: The Journal of the North American Menopause Society. 2008;15:584.
- Schonberg MA. After the Women's Health Initiative: Decision making and trust of women taking hormone therapy. Women's Health Issues. 2005;15:187.
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