Date: April 1st, 2003
Women have relied on hormone therapy for decades to relieve symptoms of menopause. But with last year's dramatic announcement about the risks of hormone therapy, women suddenly faced an agonizing choice: Was relief from hot flashes really worth the increased risk of heart disease or breast cancer?
The National Institutes of Health study, known as the Women's Health Initiative, found that the most common form of hormone therapy, estrogen-progestin pills, significantly increased the risk of stroke, heart disease, and breast cancer.
NIH researchers concluded that these risks far outweighed the pills' benefits of preventing hip fractures and colorectal cancer, especially since other non-hormone treatments are available to safely fight bone loss and colon cancer.
Specifically, researchers found that women taking the estrogen-progestin combination are at much higher risk of cancer and heart disease than previously thought. However, on the positive side, the same group of 10,000 women will have six fewer cases of colon cancer and five fewer hip fractures.
"The cardiovascular and cancer risks of estrogen plus progestin outweigh any benefits, and a 26 percent increase in breast cancer risk is too high a price to pay, even if there were a heart benefit," said Dr. Claude Lenfant, director of the National Heart, Lung, and Blood Institute, which ran the study.
What's Right for Your Body?
Choosing whether or not to use hormone therapy is one of the most important health decisions women face as they age, and the NIH study results make their decision even more complicated. Indeed, many women have abandoned hormone therapy since learning of its potential risks. But do the results really justify that decision?
First, let's consider what your body is going through. Menopause is a major shock to women's bodies, and not just their reproductive system. The brain, heart, blood vessels, and bones are filled with estrogen receptors. When the ovaries stop producing estrogen at menopause, these organs all feel the impact.
To counter these changes, menopausal hormone therapy, formerly called "hormone replacement therapy," was traditionally prescribed for two basic reasons: first, to alleviate menopausal symptoms, and second, to lower the risk of other age-related disorders like osteoporosis and heart disease.
So what's a woman to do? It's clear there is no "one size fits all" answer to the question of whether to undergo hormone therapy. Women considering hormone therapy should discuss the matter with their physicians, who can evaluate their individual medical history, risk factors, and reasons for taking hormones.
Here are some factors to consider in making your decision:
First, it's important to understand that an "increased risk" of breast cancer or other condition does not necessarily mean you will develop that condition. Your personal and family medical history plays a major role in your chance of developing the disease, as does your lifestyle.
It's also important to look at why you're considering hormone therapy. Is it simply to treat menopausal symptoms? Or is it to prevent more long-term conditions, such as osteoporosis or heart disease? If a woman hopes to reduce her risk of osteoporosis, for example, there are other options available.
"Women … who are currently taking estrogen plus progestin should have a serious talk with their doctor to see if they should continue it," said Dr. Jacques Rossouw, director of the study. "If they are taking this hormone combination for short-term relief of syptoms, it may be reasonable to continue since the benefits are likely to outweigh the risks."
The NIH study results addressed only the long-term use of estrogen and progestin (in this case, just over five years). It did not evaluate the short-term use of these hormones. However, it's possible the risks begin to increase soon after hormone therapy begins. Other studies have suggested that the risk of heart disease rises even in the first two years of hormone therapy.
But there was one clear message from the study's findings: Don't take hormone therapy for osteoporosis or heart disease. There are other drugs available to counter the effects of osteoporosis. And, contrary to earlier medical opinion, hormone therapy doesn't prevent heart disease, it actually increases the risk of heart attacks and stroke! To stave off heart disease, you should concentrate instead on losing weight or reducing high cholesterol levels.
Should you decide to avoid hormone therapy altogether, there are alternatives for alleviating the symptoms of menopause. For instance, try to avoid spicy foods and caffeine, which may trigger hot flashes. Boosting your intake of soy products may also help, since soy plants contains estrogen-like substances called "phytoestrogens." Some antidepressants have been shown to to relieve hot flashes, as well. Other lifestyle changes, such as becoming more physically active, can help calm mood swings, as well as improving your sleep.
The key is working with your doctor to tailor a program that's right for you. And it's not just a one-time decision. You and your doctor should discuss your options at least annually. Not only could your individual risk factors change, but there may also be new research on the risks or benefits of hormone therapy. Remember, your decision whether to undergo hormone therapy can be changed at any time.
For more information on hormone therapy, please download the following fact sheet and for information on other health conditions associated with menopause, click here to access the Alliance's brochure, You're in Charge.