Is hormone therapy still an option for menopausal women?

By June LaValleur, M.D.
(Updated July 14, 2005)

In recent years, women have received mixed messages from the media and their health care providers about hormone therapy. When hormone therapy--once a commonly prescribed treatment for menopausal symptoms and disease prevention--was cited as contributing to some women’s chronic health issues, many women found it difficult to determine the best treatment for their symptoms.

Some symptoms of menopause include hot flashes, insomnia, mood swings, fatigue, depression, headaches, changes in sex drive, vaginal dryness, and bladder control problems. To relieve those symptoms, women and their health care providers still may decide to use hormone therapy, but I would suggest they must be thoughtful about it.

The decision to use hormone therapy is based on an individual's past medical history, family history, risk factors, severity of menopausal symptoms, and a woman’s personal thoughts and fears about hormone therapy. I recommend that women take the lowest dose of estrogen for the shortest period of time to relieve symptoms. Standard hormone therapy is to provide estrogen-only therapy to women without a uterus and estrogen-progestin therapy to women with a uterus, to protect uterine lining.

The largest clinical trials of hormone therapy to date were performed by the Women’s Health Initiative. In 2002, the Women’s Health Initiative study of women taking estrogen plus progestin showed a slight increased risk of heart disease, stroke, and breast cancer, and a decreased risk of colorectal cancer and hip fractures. In April 2004, the Women’s Health Initiative released study results for women using the estrogen-only therapy, which indicated a slight increased risk of stroke with no increase in breast cancer. As a result, even though hormone therapy formerly was assumed to provide protection against cardiovascular disease, now it is not recommended for postmenopausal women who have a high risk of chronic cardiovascular disease.

A close look at the Women’s Health Initiative data, however, reveals a possible problem. Women typically use hormone therapy to relieve menopausal symptoms that often begin when women reach their 40s. But the Women’s Health Initiative studied post-menopausal women ages 50 to79, a problematic choice because most of the older women studied were not experiencing menopausal symptoms. A study of women in early menopause would have been more valuable in increasing our understanding of possible hormone therapy benefits.

Because of these studies, many women and providers have extrapolated that hormone therapy is dangerous for all women, without understanding that the study looked only at post-menopausal women.

While estrogen is still the best remedy for the symptoms of menopause, some women have also had success with alternative therapies. A diet without caffeine, alcohol, and spicy foods is thought by some researchers to reduce hot flashes. Exercise, black cohosh (an herbal supplement), and other medications may also relieve symptoms.

It is recommended that women consult with their health care providers to find the best treatment for menopausal symptoms. For further information on hormone therapy, I recommend the North American Menopause Society (NAMS) at http://www.menopause.org.

June LaValleur, M.D., is associate professor, Department of Obstetrics, Gynecology and Women's Health. She is also the co-director of education for the National Center of Excellence in Women's Health. This column is an educational service of the University of Minnesota. Advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu