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Menopause: Making sense of HRT |
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Once considered a panacea for change-of-life, HRT's benefits are now in doubt. The latest study findings may give you pause - but talk to your doctor about what's right for you. For years, women have been told that hormone replacement therapy (HRT) is the best way to reduce certain age-related health risks - most notably heart disease and osteoporosis. But studies published as recently as 2003 indicate that HRT may often have risks that outweigh its benefits. What's more, while the estrogen-progestin combination can relieve menopausal symptoms and slow the development of osteoporosis, it doesn't seem to improve the general quality of life. So what should you do? Talk to your doctor. Years ago, HRT was frequently prescribed after menopause. But now, more than ever, it needs to be considered on a case-by-case basis. Your family physician or gynecologist can help you understand the results of scientific studies, and evaluate the benefits-versus-risks for you. What the research shows Menopause, the ending of a woman's reproductive capacity (and simultaneously her periods), is marked by various moderate-to-severe symptoms: hot flashes and night sweats; sleeplessness; emotional ups and downs; and genital burning, itching or dryness. HRT has been the subject of various studies, most notably the Women's Health Initiative (WHI). WHI is a set of clinical trials, including two estrogen-progestin trials, in healthy postmenopausal women ages 50 to 79, which was scheduled to be completed in 2005. However, one of the trials (continuous, combined estrogen-progestin versus placebo in more than 16,000 women) was discontinued early because of an increased risk of breast cancer, coronary heart disease, stroke and venous thromboembolism over an average follow-up of 5.2 years. Although significant benefits were also seen (reduction in risk of fractures and colon cancer), there was concern that the risks of combined estrogen-progestin outweighed the benefits for many women. |
In summary, women who take HRT have stronger bones and less colon cancer, but they are at an increased risk for breast cancer, heart attack, stroke and serious blood clots. To put the risk in perspective, each of these serious events would happen to fewer than one in 1,000 women per year because of HRT, but would be expected to happen to seven or eight in 1,000 women over 10 years. Many physicians now recommend that their patients on HRT stop taking it to prevent osteoporosis, though some women continue to take it because of severe menopausal hot flashes or emotional symptoms off estrogen. What it means for you Factors such as your health history and your family's health history will be important when weighing the risks and benefits of HRT. You and your doctor may still decide that combination estrogen-progestin therapy is appropriate for you, perhaps to relieve menopausal symptoms. But make sure you use the lowest dose possible - for the shortest duration. With many HRT products and methods of delivery on the market, you and your doctor can individualize a regimen that's best for you. For example, vaginal dryness can be treated with estrogen cream without the risk of HRT pills. In the meantime, stay tuned. Since research is continuing, the hope is that future results will clarify existing confusion about HRT. Andrea Sattinger is a writer and health care communication advocate in Chapel Hill, N.C.
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