Weighing the Cautions on Hormone Replacement Therapy

Recent widely reported findings from a large clinical trial on hormone replacement therapy (HRT) have many women concerned--especially those who have been on an HRT regimen. Should you stop taking hormones based on the latest scientific findings?

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First, some background. About 20 million American women are on some form of estrogen therapy. Previous studies had shown estrogen treatments to be effective at calming some of the negative symptoms of menopause, such as hot flashes and sleep disturbances, and they also had been shown to help against osteoporosis and heart disease.

Last year, however, the Women's Health Initiative (WHI) suspended its massive study when it found that using a particular combination hormone therapy had increased the subjects' risks for developing breast cancer, heart attack, stroke, and blood clots in the lungs and legs.

The WHI study, which involved more than 16,000 women ages 50-79 in a randomized trial, assessed the effects of using a combined therapy of estrogen and progestin that is currently taken by an estimated six million American women. The study did find positive side-effects from taking the combination: reductions in the number of women reporting colorectal cancer and hip or other fractures. But the study was stopped after it was concluded that the long-term risks to study participants outweighed the benefits.

More recently, WHI released findings showing that, for most subjects, hormone replacement therapy did not substantially improve some of the short-term effects of menopause, such as hot flashes or sleep disturbances.

What do the latest findings from the WHI study mean for you?

First, it's important to recognize that the WHI study examined only one kind of HRT, and the risks documented by the study worsened after the fourth year of using the drug. For many women, the adverse symptoms of menopause don't last that long, and the WHI study found that using a hormone therapy for two to three years may offer more benefits than risks for you.

If you're currently using a hormone replacement therapy, you'll want to review with your doctor the specific purposes for using an HRT, as well as factors in your personal health profile that should be considered. (For example, your family's history of heart disease and cancer should factor into a decision to use an HRT.) You'll probably want to review your choice with your doctor every year, since conditions may change. If you do decide to discontinue using HRT, talk to your doctor about whether to stop gradually.

Make lifestyle changes, if necessary, to give yourself added protection against heart disease and osteoporosis. These might include exercising regularly, eating a balanced, nutritious diet, and using medications to control high blood pressure or to combat bone loss.

Finally, to combat hot flashes, avoid caffeine and spicy foods. Keep the thermostat down and dress in layers to better regulate how warm you feel.

--John O'Neil

For more background on the WHI study and recommendations regarding hormone replacement therapies, go to: www.whi.org.

Quick Tips

Get Informed
For reader-friendly background on the WHI study and its implications, contact the National Heart, Lung, and Blood Institute at 301-592-8573 or www.whi.org. You can find fact sheets on hormone replacement therapy at www.webmd.com.

Talk With Your Doctor
Your doctor can review your health profile and help you better understand the various options for dealing with symptoms of menopause.