Hormone therapy:

Choosing whether or not to use postmenopausal hormone therapy is an important health decision. The Women's Health Initiative and other studies are providing important information about the risks and benefits of long-term menopausal hormone therapy to offer women some guidance about hormone use.

Facts About Menopausal Hormone Therapy

Brand new! Revised with updated information following NIH's cessation of the estrogen-alone study. Choosing whether or not to use menopausal hormone therapy (MHT) can be one of the most important health decisions women face as they age. This 24 page brochure summarizes the latest evidence as of Summer 2005 to offer guidance about the risks and benefits of MHT. It is designed to provide patients with information to help them communicate more effectively with their care providers and determine the best course of treatment on an individual basis. This easy to read publication covers such topics as Menopause and Hormone Therapy, Alternatives to Hormone Therapy to Help Prevent Postmenopausal Conditions and Relive Menopausal Symptoms, Dietary Supplements, and more.

What is the purpose of the WHI study on combination hormone therapy?

The long-term studies in the WHI were initiated because over the years a number of research studies presented a complicated picture of the risks and benefits of hormone therapy, and its continued use for prevention of cardiovascular diseases was controversial. This situation led the NIH to conduct a large clinical trial of the risks and benefits of hormone therapy. The WHI set out to examine the long-term effect of estrogen plus progestin on the prevention of heart disease and hip fractures, while monitoring for possible increases in risk for breast and colon cancer. The estrogen plus progestin regimen was given to women who have a uterus since progestin is known to protect against endometrial cancer, a known effect of unopposed estrogen. A separate study of estrogen alone in women who had a hysterectomy was also begun.

What were the actual hormones that women in the estrogen-plus-progestin study were taking?

Women who were randomized to receive active hormones were taking conjugated equine estrogens 0.625 mg each day and medroxyprogesterone acetate 2.5 mg each day. This is the most commonly prescribed postmenopausal hormone therapy in the United States for women who have a uterus (used each day by more than six million women).

Do you have recommendations about other hormone alternatives (lower-dose estrogens, micronized progesterone, natural hormones)?

We cannot make specific recommendations about other hormone medications, such as different estrogens or progestins. We also cannot make recommendations about hormones women take in lower dosages or in different ways, such as patches instead of pills.Futher, without scientific clinical trial data, one cannot assume that alternative estrogen plus progestin treatments are any safer than those studied in WHI.

Postmenopausal Use

Menopause may cause other changes that produce no symptoms yet affect your health. For
instance, after menopause,women’s rate of bone loss increases.The increased rate can lead to osteoporosis, which may in turn increase the risk of bone fractures.The risk of heart disease increases with age, but is not clearly tied to the menopause. Through the years, studies were finding evidence that estrogen might help with some of these postmenopausal health risks— especially heart disease and osteoporosis.With more than 40 million American women over age 50, the promise seemed great. Although many women think it is a “man’s disease,” heart disease is the leading killer of American women.Women typically develop it about 10 years later than men. Furthermore,women are more prone to osteoporosis than men. Menopause is a time of increased bone loss. Bone is living tissue. Old bone is continuously being broken down and new bone formed in its place.With menopause, bone loss is greater and, if not enough new bone is made, the result can be weakened bones and osteoporosis, which increases the risk of breaks. One of every two women over age 50 will have an osteoporosis-related fracture during her life. Many scientists believed these increased health risks were linked to the postmenopausal drop in estrogen produced by the ovaries and that replacing estrogen would help protect against the diseases.

Putting It All Together

The WHI findings finally offer women guidance about the use of menopausal hormone therapy. They establish a causal link between use of the therapies tested and their effects on diseases. Further, the results apply broadly— the studies found no important differences in risk by prior health status, age, or ethnicity. As you read the information given below, realize that most treatments carry risks and benefits.Talk with your doctor or other health care provider and decide what’s best for your health and quality of life. Begin by finding out your personal risk profile for heart disease, stroke, breast cancer, osteoporosis, colorectal cancer, and other conditions (See Boxes 11, 12, 13, 15, 16, 17, 18, and 19.). Discuss quality of life issues and alternatives to menopausal hormone therapy. Box 20 will help you talk with your health care provider. Then weigh every factor carefully and choose the best option for your health and quality of life. And keep the dialogue going— your health status can change and so can your choice.

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