During the 1990s, millions of menopausal and post-menopausal women were taking hormone replacement therapy (HRT) with the hopes that the treatment would not only reduce menopausal symptoms, but decrease the risk of some chronic conditions such as heart disease.
In a majority of cases, HRT worked well to reduce symptoms of menopause such as hot flashes and night sweats. But in 2002 a major study was released that shook up the entire world of HRT for women, and the use of female hormones dropped precipitously. The Women’s Health Initiative Study (part of the National Institutes of Health, USA) found that HRT was dangerous, and should not be used.
The Women’s Health Initiative (WHI) study was actually stopped early because the researchers did not want more women harmed. The early findings showed that HRT increased the risk of cardiovascular disease, stroke, and breast cancer. So many women went off HRT and unfortunately returned to their sometimes miserable menopausal symptoms.
Since 2002, a number of other HRT studies have been performed that have brought into question the results of the WHI study, but still, just recently, in October 2012, the United States Preventive Health Task Force released a report basically confirming the WHI study and recommended “against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women.”
Despite this report, a number of experts in the field believe that each woman’s case needs to be considered individually. For example, Dr. Maude Guerin, a member of the North American Menopause Society (NAMS) says “Every patient is like a Rubik’s cube, and you have to find the right solution for her. Hormones are not a panacea or a weapon of mass destruction.”
One reason for the questioning of the 2002 WHI study is that it was conducted mostly in women in their 60s and 70s, an average of 12 years past menopause. An newer analysis of the data from the WHI regarding younger women—those in their 50s—showed that HRT actually lowered their risk of heart disease and that they were less likely to die from any cause during the time they were in their 50s and on HRT.
The HRT is complex, and involves plusses and minuses for not only heart disease, stroke, and breast cancer, but also—in a good way or bad way depending on the risk profile and age of the woman—diseases such as dementia, gallbladder problems, osteoporosis, colon cancer, diabetes, as well as blood clots in the legs and lungs. Here is a chart detailing some of the general “pros” and “cons” of HRT:
• Lowers risk of osteoporosis and fractures
• Lowers risk of diabetes
• Lowers risk of colon cancer
• Reduces hot flashes and night sweats
• Reduces mood swings
• Prevents vaginal atrophy
• May lower cardiovascular risks in healthy women
• Increases risk of stroke
• Increases risk of pulmonary embolism
• Increases risk of heart disease in older women
• Increases risk of breast cancer, with progestin
• Increases risk of dementia after age 65
• May increase breast tenderness
Many experts now believe that most younger women—that is those in their 50s or who have just started menopause—can safely use HRT if they have menopausal symptoms, especially if they use them “short-term”, but that women older than 60 should try to avoid their use. Each woman though has her own family history, her own risk profile, her own symptoms, needs, and fears, and the best thing is for each woman to discuss her case with a doctor knowledgeable in the area.
The final answer on HRT is not out, and further studies are sure to come out, some that will counter what we believe now. We are sure to address this topic here again in Mais Saúde!
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