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The Latest Information on Hormone Therapy

separator In October, the American College of Obstetricians and Gynecologists issued the most comprehensive report available regarding hormone treatment (HT) for women. The report delineates the risks, benefits and still-unanswered questions about HT.

More than two years ago, in the summer of 2002, the Women’s Health Initiative issued a landmark study showing that estrogen plus progestin is effective for the temporary relief of menopausal symptoms such as hot flashes and night sweats. But the study also showed that taking the hormones on a long-term basis could increase a woman’s risk of heart attack, cancer and stroke.

After the study was published, about 65 percent of the women who had been taking HT stopped the treatment immediately. In the time that’s passed since that study, there have been some additional findings: 

  • Estrogen therapy (ET) alone, which is used by women who have had a hysterectomy, also increases the risk of blood clot and stroke. It too should not be used on a long-term basis for prevention of disease. And while ET does pose fewer risks than combined HT, women who still have a uterus should not take estrogen because it increases their risk of uterine cancer.
  • For 90 percent of women, hot flashes last for about four years. But women whose hot flashes last longer should not rule out continuing on HT, even though it’s recommended that patients stay on the treatment for as short a period of time as possible. This is a decision women should discuss with their doctors.
  • Women who take HT or ET should take the smallest possible dose—just enough to relieve symptoms. And they should review their treatment each year with their doctors to determine whether they should continue or stop the therapy.

Additionally, the report issued the following information:

  • Anti-depressants in the SSRI category are often effective in stopping or decreasing hot flashes. (It’s believed that some serotonin receptors in the brain play a role in the development of hot flashes.)
  • To date, there’s no conclusive evidence that alternative herbal therapies are effective in the treatment of hot flashes. Herbs such as wild yam, black cohosh and phytoestrogen supplements produced “no significant effect” on symptoms.

One of the main messages of ACOG’s report is that there’s no single way for women and their doctors to incorporate HT into their treatment of menopausal symptoms. While the initial findings about HT scared many women into stopping these therapies completely, continued research has shown that used with caution and an understanding of the risks and benefits, hormone therapies are extremely appropriate for the relief of menopausal symptoms in many women.

Special Supplement to Obstetrics and Gynecology, October 2004.
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