Hormone Therapy

Hormone therapy is the most widely recommended and effective therapy to treat severe menopausal symptoms. However, it does not treat all the changes associated with the normal aging process. Your own personal health profile, along with carefully weighing the benefits and risk of HT, will help you make the decision that's right for you.

This section reviews the controversies surrounding HT, summarizes the latest research, and reviews the risk and benefits associated with hormone therapy use.

Benefits and Risks

Is hormone therapy right for you?

As with any medication, hormone therapy has both benefits and risks. Together with your healthcare provider, you should decide if your symptoms are severe enough to benefit from HT without creating other health problems. For some women, HT is relatively safe, while for others, the risk of adverse side effects may outweigh the benefits.

This section reviews the controversies surrounding HT, summarizes the latest research, and reviews the risk and benefits associated with hormone therapy use.

Overview  |  HT and Physical HealthHT and Mental HealthHT and Sexual Health

 

Today's Research

On July 9, 2012, 15 major medical organizations, including the North American Menopause Society (NAMS), the American Society for Reproductive Medicine (ASRM) and the Endocrine Society issued a joint statement affirming that hormone therapy is still an acceptable treatment for menopausal symptoms. Listed below are the latest guidelines on hormone therapy to help you make the most informed decision possible:

  • Hormone therapy remains the most effective treatment available for menopausal symptoms, including hot flashes and night sweats that can interrupt and diminish your quality of life. Many women up to age 50 or within 10 years of menopause can take it safely.
  • If you have had blood clots, heart disease, stroke or breast cancer, you may not want to use hormone therapy. Be sure to discuss all your existing health conditions with your OB/GYN or healthcare provider when talking about hormone therapy.
  • The length of time to safely take hormone therapy varies for estrogen progestin therapy (EPT) vs. estrogen therapy (ET). For EPT, limit your use to 3-5 years due to the increased risk for breast cancer. The risk decreases after hormone therapy is stopped. For ET, you can take it for up to 7 years, as no sign of an increased risk for breast cancer was seen during that treatment time.
  • If you are healthy and under the age of 60, you will have no increase in the risk of heart disease with hormone therapy. However, the risks of stroke and blood clots in the lungs are increased, similar to the risks found when using birth control pills.
  • If your symptoms are limited to vaginal dryness or discomfort, you should consider using low dosages of local vaginal estrogen.
  • While all the research evidence is not yet available, estrogen therapy (ET) that is delivered transdermally (through the skin) by patch, cream, gel or spray and low-dose oral estrogen may have lower risks of blood clots and stroke than standard doses of oral estrogen.
  • Both oral and transdermal hormone therapy resulted in an increase in vaginal lubrication and a decrease in painful sexual intercourse for women.
  • Transdermal hormone therapy was associated with improved libido-related aspects, such as desire, arousal and orgasm.

Overall, the latest research shows that hormone therapy is a reasonable option for many women, but not for all. It depends on the extent and severity of symptoms and how everyday life is affected. When making the decision to use hormone therapy, factors such as family history, symptom severity, age and time since menopause began, preexisting health conditions, your lifestyle and method of administration should all be considered. Talk with your OB/GYN or healthcare provider about the importance of individualized care and personalized decision making. Together, you can weigh your risks and benefits to allow you to make the most informed decision possible.

History/Controversy

 

In the 1940's, the FDA approved the use of estrogen to treat hot flashes associated with menopause. Because women felt better while taking hormones, the list of other beneficial claims relative to the effects of aging grew despite the lack of sound research. In 1990, the FDA found that the research done to date was not adequate to take hormones to prevent conditions like heart disease. This led to an extensive 15 year, multiphase drug trial called the Women's Health Initiative (WHI) on hormone therapy for menopausal women, conducted by the National Heart, Lung & Blood Institute (NHLBI) of the National Institutes on Health (NIH). However, the estrogen/progestin arm of the study was stopped in 2002 due to the increased risk discovered for breast cancer, stroke, blood clot and heart attack. The researchers at that time determined that the many health risks associated with combination hormone therapy outweighed the benefits.

This led to widespread uncertainty for women regarding the safety of hormone therapy and caused many to stop using hormone therapy completely. Unfortunately, the WHI focused on older women (average age 64) who were more advanced in the aging process. If it had included more women who took hormone therapy at the start of menopause, it may have had different results.

Since the WHI drug trial, research on hormone therapy has continued with greater emphasis on age variables, different dosages and delivery methods.