Is Hormone Replacement Therapy Making a Comeback?
From the 1970s to the early 2000s, hormone replacement therapy developed a reputation as veritable fountain of youth. Millions of women entering menopause were told by their doctors that it would not only ease menopause symptoms such as hot flashes but also provide a range of other benefits, including healthier hearts. The suggestion seemed to make sense. After all, estrogen plummets after menopause and the risk of heart disease rises.
The only problem was that there was little proof of those benefits. And when randomized clinical trials—the gold standard in medical research—were finally completed in 2002, the findings punctured many assumptions and showed that the therapy even increased some health risks.
Now, however, some doctors are suggesting the tide is turning again—or at least that there are some circumstances when hormone replacement can make sense.
Here's our advice.
Emerging Evidence
The study that turned the tide against the routine prescribing of hormone replacement therapy was the landmark Women’s Health Initiative. Based on a trial of about 17,000 women, it found that the treatment increased risk for heart disease, stroke, blood clots, and breast cancer. Other research has linked hormone replacement therapy to ovarian cancer as well.
“The days of routinely putting postmenopausal women on the hormone are over,” says Vinayak K. Prasad, M.D., an assistant professor of medicine, public health, and ethics at the Oregon Health & Science University and co-author of “Ending Medical Reversal” (Johns Hopkins University Press, 2015).
Still, several follow-up analyses of the data suggested that for short-term use by women at low risk of heart disease and breast cancer, hormone replacement therapy can be relatively safe.
And other research suggested that some of the risks of hormone replacement therapy could be reduced by using a transdermal estrogen patch instead of taking oral doses, says Marvin M. Lipman, M.D., a board-certified endocrinologist and Consumer Reports' chief medical adviser.
As a result, judicious use of supplemental estrogen can be an option for some women with severe hot flashes and certain other menopausal symptoms, says Lipman and other experts.
When to Consider Supplemental Estrogen
Hormone replacement therapy after menopause remains the exception, not the rule.
Don’t take the hormone if your menopause symptoms are mild and can be managed by lifestyle changes, such as sleeping in a cooler room, exercising regularly, and limiting alcohol and caffeine.
Also avoid hormone therapy if you have heart disease, diabetes, high cholesterol, or high blood pressure, or you’ve had breast, ovarian, or uterine cancer.
But if your hot flashes are severe, you don’t have any of those risk factors, and you’re within the first five to 10 years of menopause, then it’s reasonable to discuss the option with your doctor.
Ask your doctor about the transdermal patch. And if you start it, stay on it for the shortest time possible (less than three to five years) and stop after age 60.
And don’t use estrogen therapy for other menopause-related symptoms, like mood swings, irritability, forgetfulness, and reduced libido. There’s no evidence it helps those problems.
You should also avoid compounded “bioidentical” hormone replacement therapy products made in pharmacies because they’re not regulated by the Food and Drug Administration and may not be safe.
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