Benefits of hormone therapy for menopause symptoms outweigh risks, study finds : Shots

Low-dose estrogens can be taken orally, but they are now also available in patches, gels, and creams.

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Low-dose estrogens can be taken orally, but they are now also available in patches, gels, and creams.

svetikd/Getty Images

The benefits of hormone therapy for treating menopausal symptoms outweigh the risks. This is the conclusion of a new study published in the medical journal JAMA.

“In women younger than 60, we found that hormone therapy has a low risk of adverse events and is safe for treating bothersome hot flashes, night sweats and other symptoms of menopause,” says study author Dr. JoAnn Manson, head of the department of preventive medicine. at Brigham and Women’s Hospital. This is a departure from the advice many women have received in the past.

The new analysis is based on two decades of follow-up data from the Women’s Health Initiative study, which followed thousands of women taking hormone replacement therapy. The study was stopped after it was found that women taking Prempro, which is a combination of estrogen and progestin, had higher risks of breast cancer and stroke.

“The results were surprising,” Manson says, noting that the reason the randomized trial was conducted was because scientists were trying to determine whether hormone therapy reduced the risk of heart disease and other conditions.

After the initial results, many women stopped treatment abruptly. Prescriptions have dropped and many healthcare providers are still hesitant to recommend hormone therapy. But menopause experts say it’s time to reconsider hormone therapy, because there’s a lot we know today that we didn’t know twenty years ago.

More importantly, there are now different types of hormones – given in lower doses – that are proven to be safer.

“Women should know that hormone therapy is safe and beneficial,” says Dr. Lauren Streicher, clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.

In hindsight, Dr. Streicher says, it’s clear that the Women’s Health Initiative study was flawed and that some of the risks identified were related to the type of hormones given to women.

“We learned what not to do,” Streicher says. The type of progestin used, called medroxyprogesterone acetate, was “very problematic,” she said. This is likely responsible for the increase in breast cancer observed among women in the study. “So we don’t prescribe it anymore,” says Streicher.

Increasingly, other types of hormones are being used, such as micronized progesterone, which does not increase the risk of breast cancer,” says Streicher. Micronized progesterone is a bioidentical hormone that has a molecular structure identical to the progesterone produced by women’s ovaries and which tends to have fewer side effects.

Another problem with the study was the age of the women enrolled. Most of the women were over 60, Streicher said. “And we know that there is a window of opportunity when it is safest to start hormone therapy and you will get the greatest benefit from it.” That window is usually between 50 and 60 years, she says.

Another risk identified in the Women’s Health Initiative study was an increased incidence of pulmonary embolism in women taking hormones. A pulmonary embolism is a blood clot that blocks blood flow to the lungs.

Because the women in the study were taking estrogen orally, in pill form, that may have increased their risk, Streicher says. A better option for people at risk of clots is to take estrogen through the skin, via a patch, cream, or gel.

“The advantage of transdermal estrogen is that it is not metabolized by the liver,” says Streicher. “And because it’s not metabolized by the liver, we don’t see this increase in blood clots.”

With a range of hormonal therapies available today, Dr. Streicher says there is no one-size-fits-all approach. “Hormone therapy is beneficial far beyond just helping with hot flashes,” she says. Current research also suggests protection against bone loss and heart disease.

Streicher says women should talk with their health care providers about options that might best meet their needs.

This story was edited by Jane Greenhalgh

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Gn Health

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