“A Decade after the Women’s Health Initiative scared the h_ll out of women!”
The Women’s Health Initiative (WHI) was presented to the press in 2002 before it was released to the medical community and way before they had a chance to carefully stratify the data. Meaning, they didn’t account for age primarily.
The bottom line – no new news! Hormone replacement therapy (HRT) is safe and important in young healthy women (less than 55 – 60) and may present problems in older women.
Unfortunately, we are still only recommending it for symptomatic menopausal women. The two-thirds of women who don’t have hot flashes, night sweats, etc. aren’t currently encouraged to go on HRT. Something many of us hope will change. All women that take HRT live longer than women who don’t, a fact for over 50 years.
Estrogen is the hormone that treats the symptoms and progesterone is necessary to prevent uterine cancer. Since the women taking estrogen alone in WHI had no increase in breast cancer, it appears that progesterone is the troubling hormone (needed only in women who have their uterus). Research is underway to figure out if specific types of progesterone are better than others (natural, bio-identical, synthetic, compounded etc).
Hormones have other benefits besides eliminating hot flashes. They help maintain strong bones, reduce the risk of heart disease and reduce the risk of increased cholesterol (if you’re young). Hormones help with vaginal dryness, delay the changes of aging in your hair, nails, and skin. The benefits of hormones on the bladder and it’s function are mixed. For some reason, women in WHI also had a reduced risk of colon cancer that was not related to increased surveillance.
Like anything in life – there are always risks. They are rare, especially in younger women. Blood clots are possible with all hormones but HRT use is associated with less risk than that associated with birth control pills and pregnancy! The WHI study showed a slight increased risk of breast cancer when taking both hormones for 5 or more years and the risk decreases to normal after cessation of use.
How long should women stay on HRT (estrogen and progesterone)? Well it’s hard to say, but 5 years is certainly safe. We recommend continuing hormone therapy if symptoms persist. For estrogen alone, 10-15 years is probably appropriate.
Estrogen administered through the skin (patch and creams) have a lower risk of blood clots and stroke than standard oral pills. If you don’t mind something stuck to your skin and you have had a hysterectomy, this might be a safer option. Compounding and bio-identical hormones are gaining popularity but don’t have the safety data available or years of experience that traditional HRT has. (See our bio-identical video in the health library section of our web site.)
Conclusion: Hormones have an important role in managing menopausal symptoms. Endorsed by nearly every medical society, they help treat symptoms and have other health benefits. There are few downsides in younger women (< 60 years old).