Hormone replacement safe and effective menopause treatment, study finds

Women in the throes of menopause know the transition is anything but fun. The symptoms can include hot flashes, irritability, migraines, and changes in sexual desire and function.

Hormone replacement therapy has ebbed and flowed in its popularity over three decades, with a mixed picture of its risks and benefits. This new review of long-running data suggests that, for women in early menopause, the benefits of hormone replacement therapy do outweigh the risks.

For a closer look at the evidence, I'm joined by Dr. Lauren Streicher. She's a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of medicine.

Dr. Streicher, thank you so much for joining the "NewsHour."

So, in the early 2000s, there was a lot of fear that started to emerge around hormone replacement therapy's correlation with breast cancer and other diseases. Can you just put into context how disruptive those findings were for women's health back then and how this new study fits into our understanding of safety today?

Dr. Lauren Streicher, Clinical Professor of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine: Well, certainly, what happened 22 years ago, when the WHI was first released, was a huge deal, because it was terrifying for the millions of women who'd been taking their hormone therapy, thinking that not only would it relieve their menopause symptoms, but that it might also help in terms of prevention of chronic diseases.

And, within one day, people were literally flushing their hormone therapy down the toilet out of fear that this hormone therapy that had been recommended by their doctors was going to give them breast cancer, heart disease, blood clots.

And this completely changed the trajectory of not only women's attitudes about hormone therapy, but doctors' attitudes about hormone therapy.

Now, just to be clear, this is not a new study. This is not new data. This is a new statement about old data from a study which, quite frankly, was poorly designed from the get-go using hormone therapy that's no longer even prescribed by most experts.

Dr. Lauren Streicher:

Well, that's actually a complicated question, because we're really looking at two groups of symptoms. We're looking at the short-term issues, the hot flashes, the vaginal dryness, the brain fog, the moodiness, the insomnia.

But we're also looking at big picture, at long-term issues, not only prevention of chronic disease, such as heart disease, which is the number one thing that kills women, but things like different cancers, breast cancer, uterine cancer, cognitive function down the road, joint pain, sexual function.

So, in terms of which women would benefit, well, clearly, the group that's going to benefit at the onset of menopause are the women who are having the severe symptoms, particularly hot flashes and insomnia. And there's this idea that hot flashes aren't harmful. Dress in layers, carry a fan, you will get through it.

Well, first of all, we know that they last an average of seven to 10 years. And, in fact, hot flashes are correlated with heart disease and other serious long-term medical issues. So, clearly, women that are having these symptoms early in menopause are candidates for hormone therapy.

But the bigger question is, what about the long term? And when we look at bone health specifically, this is a big deal. Women die from osteoporosis. And so they may not have any symptoms of bone loss during perimenopause, but they are starting to lose bone. And we know from this WHI data that women who start their hormone therapy in that golden period of time between 50 and 60 have a 33 percent decreased risk of fracture.

But the minute they go off their hormone therapy, they start to lose bone again. So we're not just talking about short-term hormone therapy. We're talking about long-term hormone therapy, quite frankly, lifelong hormone therapy, to prevent those kinds of long-term problems, which cause women to not only have a significant decrease in quality of life, but also length of life.

Dr. Lauren Streicher:

Yes.

Well, when we look at — there's two groups of women when we're talking about breast cancer specifically. There are women that are concerned about getting breast cancer, and then there are women that already have a breast cancer diagnosis.

So let's first just quickly talk about women who are concerned about getting breast cancer. What we know, and this is not controversial — this is not only from WHI data, but many subsequent studies — is that women that take estrogen alone have a decrease, a decrease, a 20 percent decrease in getting breast cancer.

We also know that women who have breast cancer who are taking hormone therapy at the time that they're taking breast cancer have a 40 percent decreased risk of dying from breast cancer. So, estrogen is protective. And this is what the — and this is the message that is not getting out, both from women talking to other women, but also, really problematically, by clinicians.

Physicians are not advising patients to take hormone therapy. They're not comfortable with it. Most physicians, quite frankly, weren't trained in hormone therapy because they trained after the WHI.