Understanding the Study Results
Recent reports have shown that certain hormone replacement therapy (HRT), used over the long term, probably doesn’t benefit women as much as it puts them at increased risk for breast cancer and heart disease. Women are now facing some difficult decisions. Should they stop their treatment? Should they consider starting HRT? And just how risky is HRT?
Menopause and HRT 101
Menopause occurs when your ovaries stop producing estrogen. Symptoms of menopause can include
- Hot flashes
- Vaginal dryness
- Difficulty sleeping
- Mood swings
- Change in sexual desire
Additional, longer-term consequences of the decrease in estrogen include an increase in fractures due to bone loss and an increase in heart disease.
As researchers learned about the effects of estrogen loss on a woman’s body, they came to believe that HRT would not only help treat the short-term symptoms, but also help women decrease their fracture and heart disease rate. There was also something of a “fountain of youth” feeling about HRT. It was seen as a kind of “cure-all” for the aging woman.
But the studies at that time were observational, not the randomized, controlled trials like the Women’s Health Initiative and the Heart and Estrogen/progestin Replacement Study (HERS). In these studies, healthy women were assigned at random to take the hormones or to take a placebo. This kind of large-scale trial provides much more comprehensive, reliable information.
What are the risks of HRT?
The study by the Women’s Health Initiative showed that if 10,000 women took a combination of estrogen and progestin for one year and 10,000 women did not, women taking the hormones would have
- 8 more cases of invasive breast cancer
- 7 more heart attacks
- 8 more strokes
- 18 more instances of blood clots (8 of those clots would be in the lungs)
Furthermore, there was no indication that HRT provided preventive benefits either. Because of these risks, the study was stopped. The original intention was for it to go on until 2006.
Main message: no need to panic
One thing all women who have been taking hormones should know is that the risk is small for each individual. It’s there, but the odds are still in your favor. And many doctors agree that HRT is still a good treatment option for the unpleasant hot flashes that many women experience during menopause.
If you’re on HRT and you think you want to stop taking it, be sure to talk about that with your doctor. It’s generally best to taper off your dosage gradually in order to decrease the chances that you’ll have hot flashes.
Many questions remain
Remember, the study results were about the combination of estrogen and progestin, the most commonly prescribed HRT regimen. Researchers still don’t know the effects of taking estrogen alone, which many women who have had a hysterectomy often take. They don’t know whether taking a lower dosage of the hormones is safer. They don’t know whether the estrogen that’s more like the estrogen a woman’s body produces, one that’s “bio-identical,” is safer either.
If you’re on HRT now, the best thing to do is talk with your doctor about your individual need for treatment. A lot of women are taking HRT for somewhat “across the board” reasons—to prevent fractures and heart disease, and in general to try to keep themselves from feeling the effects of menopause.
It’s important to remember that menopausal symptoms vary greatly from woman to woman. If your menopausal symptoms are giving you a lot of trouble, the indications are that HRT for a short period of time may be helpful. You may want to try HRT for a year or so, and then see how you feel when you stop taking the hormones. This is something you need to talk with your doctor about so that you can make the most well informed decision possible.
American Medical News, 5 August 2002; Journal of the American Medical Association, 17 July 2002; The North American Menopause Society