Hormone replacement therapy for menopause symptoms is safer than earlier thought

Original source (on modern site) | Article images: [1]

Hormone therapy's benefits to treat menopausal symptoms outweigh the risks for women under 60. And it's safer than previously thought, according to a new study published in JAMA, the journal of the American Medical Association. But the use of menopausal hormone therapy is not recommended to prevent heart disease, stroke, dementia or other chronic illnesses. It doesn't reduce those risks.

The study says roughly 55 million women in the U.S. and 1.1 billion worldwide are postmenopausal. A national coalition of researchers launched the Women's Health Initiative, which is the biggest study of women's health in the country, enrolling 161,808 postmenopausal women ages 50 to 79, "to inform clinical practices" around aspects of health impacting older women. Recruitment for the study began in 1993 and each participant was followed for up to 20 years.

For years, it was believed that hormone replacement therapy lowered the risk of heart disease, stroke, dementia, chronic disease and even death. But as United Press International reported, one of the Women's Health Initiative's clinical trials "slammed the brakes on hormone replacement therapy in 2002, however, reporting that women taking combination (estrogen and progestin) hormone therapy had an increased risk for breast cancer, heart disease, stroke and blood clots."

But they continued to study the issue, as the popularity of hormone replacement therapy dropped and many doctors stopped prescribing it. The article said that "a more nuanced picture of hormone therapy's risks and benefits has emerged" as the research continued.

The article said that research over time has continued to show that hormone therapy doesn't solve age-related risks like heart disease or hip replacements, which other early studies suggested. But it's not as risky as believed for younger women bothered by symptoms as they approach menopause. And in menopause, hormone replacement therapy can offer relief from those symptoms. .

Per NPR, "Most significantly, there are now different types of hormones — delivered at lower doses — that are shown to be safer."

"Women should know that hormone therapy is safe and beneficial," Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, told NPR.

Other findings

The same study's findings do not support routinely recommending women take calcium plus vitamin D supplements to prevent fractures, "but these supplements are appropriate to fill nutritional gaps" for women who don't get enough of those nutrients through their diet, the researchers said.

They also noted that "a low-fat dietary pattern with increased intake of fruits, vegetables and grains did not prevent breast or colorectal cancer, but was associated with lower rates of death from breast cancer in long-term follow-up, offering an option for women seeking to reduce this risk," Dr. JoAnn Manson, chief of Preventive Medicine at Brigham and Women's Hospital and first author of the new report in JAMA, said in a news release. "Women also have more options for treatment now, including estrogen in lower doses and delivered through the skin as a patch or gel, which may further reduce risks; non-hormonal treatments are also available."

Four things to know

The Mayo Clinic News Network talked with Dr. Taryn Smith, one of Mayo's internists and women's health specialists, about the value of a personalized approach to medicine when it comes to hormone replacement therapy. Smith offered four things women should know:

• Hormone therapy is prescribed to manage symptoms of menopause, including hot flashes, night sweats, irritability and sleep disturbance.
• Hormone therapy comes in many forms, including patches, gels, sprays and oral medications.
• Hormone therapy typically provides relief, sometimes completely, from menopause symptoms.
• Hormone therapy is generally safe for "the average woman who is close to the menopause transition and younger than 60."