Study Explores Controversial Hormone Therapy for Menopause—With Surprising Results
A follow-up study to the Women’s Health Initiative finds that hormone replacement therapy is beneficial for women in menopause.
The therapy can help relieve symptoms like hot flashes and night sweats.
The researchers say the findings are meant to clarify misconceptions about hormone replacement therapy.
Back in 2003, preliminary results were published from the Women’s Health Initiative clinical trial that linked hormone replacement therapy used to treat symptoms of menopause to a higher risk of developing serious health conditions, including heart disease and stroke. The study was halted as a result of the findings and many women have avoided hormone therapy for menopause as a result.
But the findings of the study were later debunked, and other researchers discovered that the original study looked at women who were 65 and up who already had a greater risk of heart attack, stroke, blood clots, and more, which ended up skewing the data. The study also didn’t factor in how old the women were when they started hormone therapy, which further muddled the results.
Now, a longitudinal follow-up to the Women’s Health Intitiative (WHI) study is out in JAMA—and the findings suggest that women in menopause are just fine to take hormone therapy.
“The WHI findings should never be used as a reason to deny hormone therapy to women in early menopause with bothersome menopausal symptoms,” lead study author JoAnn E. Manson, M.D., chief of the division of preventive medicine at Brigham and Women’s Hospital and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School, said in a press release. “Many women are good candidates for treatment and, in shared decision making with their clinicians, should be able to receive appropriate and personalized healthcare for their needs.”
Dr. Mason also noted that women have more options for treatment now, including receiving estrogen in lower doses and delivered through the skin as a patch or gel “which may further reduce risks.”
But the study findings stop short of saying that hormone therapy will help with health issues associated with menopause, like bone loss, dementia, and heart disease, although other studies have found it may be helpful. That’s caused several doctors who treat women in menopause to be frustrated. Here’s what you need to know.
What did the study find?
The new study looked at long-term follow-up data of up to 20 years from the Women’s Health Initiative. It found that women below the age of 60 had lower rates of adverse events and a more favorable benefit-to-risk ratio of hormone therapy than women in later menopause. Meaning, they got more out of doing hormone therapy than not taking it.
The study results found that women in early menopause had less moderate-to-severe hot flashes, night sweats, and other symptoms of menopause when they were on hormone therapy. However, they concluded that hormone therapy should not be used to prevent heart disease, stroke, dementia, or other chronic diseases.
The study also looked at calcium and vitamin D supplements, concluding that these should not be recommended to prevent fractures in all postmenopausal women. However, researchers also found that calcium and vitamin D supplements may be helpful to fill in nutritional gaps for women who don’t get enough in their diet.
The researchers also concluded that a low-fat diet with more fruits, vegetables, and grains didn’t reduce the risk of being diagnosed with breast or colorectal cancer, but it was linked with a lower risk of dying from breast cancer.
How is hormone therapy different from hormone replacement therapy?
Hormone therapy and hormone replacement therapy are terms that are usually used interchangeably. Both terms are used to describe a medical treatment that may help relieve the symptoms of menopause and perimenopause (the period before menopause), according to the American College of Obstetricians and Gynecologists (ACOG). This can also be referred to as “menopausal hormone therapy.”
“The Menopause Society uses the term ‘hormone therapy’ to acknowledge that we’re not trying to replace pre-menopause levels of hormones,” says Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “But hormone replacement therapy is a term that most women are familiar with.” Doctors will often use the term menopausal hormone therapy when discussing this topic, though, Dr. Streicher says.
“You could make an argument that hormone therapy applies to treatments like estrogen vaginal cream for vaginal dryness that has no systemic benefits, but they’re usually used interchangeably,” says G. Thomas Ruiz, M.D., lead ob/gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.
What do doctors who treat women in menopause think of these findings?
There are mixed emotions about this study. “This is really not astonishingly new information,” says Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine and founder of Madame Ovary. “We know from previous studies that hormone therapy is quite safe in women proximate to menopause and that indeed it is the most effective intervention for women suffering from many menopausal symptoms.”
But, despite its benefits, many women are scared of the idea of taking hormone therapy given the findings of the original Women’s Health Initiative study. “This study can help with reassuring women that hormone replacement therapy is, in fact, beneficial,” says women’s health expert Jessica Shepherd, M.D., an ob/gyn in Texas and author of the upcoming book on menopause, Generation M. “However, there needs to be a more demonstrative approach to show the benefits and how to use hormone replacement therapy preventatively.”
But some doctors are frustrated with these findings. “Saying that this study should never be used as a reason to deny hormone therapy? Guess what? That’s exactly what the effects of the original study were,” Dr. Ruiz says.
Dr. Streicher calls the study “infuriating,” adding, “they’re taking data that was poorly designed and flawed in the first place and are commenting on it.”
Dr. Streicher also says the conclusion that hormone therapy shouldn’t be used to lower the risk of heart disease and breast cancer is tricky, given that other studies have found hormone therapy can be a helpful tool for lowering risk. Dr. Minkin agrees.
“The one major anxiety of American women is breast cancer,” she says. “Even in the initial WHI studies, the group of women who were taking estrogen alone never showed any increased risk of breast cancer on estrogen alone; indeed they showed a reduced risk of breast cancer. And followup long-term studies on estrogen plus progestin showed no increases in mortality from estrogen and progestin. So, we have very good documentation of safety.”
For prevention, “we do know that estrogen therapy is protective against developing osteoporosis,” Dr. Minkin says. “We also know that for very young women, particularly those under the age of 45 who were not studied in the WHI study—that looked exclusively at women over 50—that estrogen therapy is vital to help protect those very young women against heart disease and dementia,” she says. But that data is not addressed in this particular study because the Women’s Health Initiative study only looked at women over the age of 50, Dr. Minkin says.
What to do if you’re interested in hormone therapy for menopause
There is still a lot of misinformation tied to the original Women’s Health Initiative study, and some doctors are not up to speed on current data surrounding the benefits of hormone therapy, Dr. Ruiz says.
That’s why he and other ob/gyns recommend seeing a specialist if you’re interested in taking hormone therapy for menopause. “See someone who knows what they are talking about and understands the data,” Dr. Streicher says. “They should be able to help you find the right treatment based on your personal circumstances and goals.”
The bottom line
It’s up to patients and their healthcare providers to determine if HRT is right for them. Dr. Manson tells Prevention that the follow-up WHI study was designed to “provide clarification” to healthcare providers on the use of hormone therapy in menopausal women. “I’ve heard from women across the country saying that they’re having trouble finding someone who will still prescribe hormone therapy,” she says. “We’re saying very clearly from the WHI investigators who know the trials extremely well that these findings should not be used as a reason to deny hormone therapy to women seeking treatment of bothersome menopausal symptoms.”
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