The Experts Do Agree About Hormone Therapy

hormone therapyTen years have passed since publication of the first results of the Women’s Health Initiative (WHI) hormone therapy trials. The debate that followed gave women and their providers the impression that the experts don’t agree on the topic of hormone therapy. The purpose of this joint statement is to demonstrate the experts do agree on the many key points.

There are a significant number of experts supporting the position that most healthy, recently menopausal women can use hormone therapy for relief of their symptoms of hot flashes and vaginal dryness if they so choose. These experts also agree that women should know the facts about hormone therapy. Below are some of the major points in reference to the use of hormone replacement therapy.

Hormone therapy reduces menopausal symptoms

  • Hormone therapy is the most effective treatment for menopausal symptoms such as hot flashes and vaginal dryness. If women have only vaginal dryness or discomfort with intercourse, the preferred treatments are low doses of vaginal estrogen.
  • Hot flashes generally require a higher dose of estrogen therapy that will have an effect on the entire body. Women who still have a uterus need to take a progestogen (progesterone or a similar product) along with the estrogen to prevent cancer of the uterus. Five years or less is usually the recommended duration of use for this combined treatment, but the length of time can be individualized for each woman.
  • Women who have had their uterus removed can take estrogen alone. Because of the apparent greater safety of estrogen alone, there may be more flexibility in how long women can safely use estrogen therapy.

Hormone therapy risks

  • Both estrogen therapy and estrogen with progestogen therapy increase the risk of blood clots in the legs and lungs, similar to birth control pills, patches, and rings. Although the risks of blood clots and strokes increase with either type of hormone therapy, the risk is rare in the 50 to 59 age group.
  • The Women’s Health Initiative trial (WHI) using Prempro (Premarin and Provera) showed there is an increased risk in breast cancer with 5 or more years of continuous estrogen/progestogen therapy, possibly earlier. The risk decreases after hormone therapy (Prempro) is stopped. Use of estrogen alone for an average of 7 years in the Women’s Health Initiative trial did not increase the risk of breast cancer. There is strong evidence to support that the type (bio-identical vs. synthetic non-bioidentical) and method (topical vs. oral) seems to be more of the issue surrounding the risks for breast cancer and not just hormone replacement therapy in general.

 

bioidentical hormones for womenAdditional information:

In large population studies, many estrogen therapies applied to the skin (patches, gels, and sprays) and certain low-dose estrogen pills have been associated with lower risks of blood clots and strokes than standard doses of estrogen pills, but studies directly comparing oral and transdermal hormone therapy have not been done.

There are many options for hormone therapy (estradiol and progesterone) that are biochemically identical (bio-identical) to the body’s own hormones.

There is a lack of safety data supporting the use of hormone therapy in women who have had breast cancer. Non-hormonal therapies should be the first approach in managing menopausal symptoms in breast cancer survivors.

The Bottom Line:

Hormone therapy is an acceptable option for many women who are bothered by moderate to severe menopausal symptoms. Individualizing care is key in the decision to use hormone therapy. Consideration should be given to the woman’s quality of life priorities as well as her personal risk factors such as age, time since menopause, and her risk of blood clots, heart disease, stroke, and breast cancer.

Many medical organizations devoted to the care of menopausal women agree that there is no question that hormone therapy has an important role in managing symptoms for healthy women during the menopause transition and in early menopause. Ongoing research will continue to provide more information as we move forward.

Portions of this excerpt were obtained from a statement article by The North American Menopause Society, and the American Society for Reproductive Medicine, and The Endocrine Society.