On the Fence? What Women Should Know about Hormones

Millions of women stopped taking hormone products after a large government study in 2002 seemingly pronounced that the risks associated with hormone use were greater than the benefits. However, by last fall a Kaiser Foundation survey revealed that at least 25 percent of these women had returned to hormone therapy. Many women find that their menopausal symptoms, such as severe hot flashes, night sweats, short-term memory loss or sleeping problems, are intolerable and that alternative therapies are simply not adequate for amelioration of these symptoms. 

The decision as to whether or not to seek hormone treatment needs to be considered for what it really is -- a quality of life issue. While not appropriate for everyone, millions of women and their physicians remain confident that hormone therapy will relieve debilitating symptoms. In fact, they cannot imagine how greatly diminished their quality of life would be without them. 

The government study that caused the recent "should-I-stay-on-(or-start)-hormones?" concern is the Women's Health Initiative. It showed that over the course of a year, if 10,000 women taking a combination of estrogen and a synthetic progestin were compared with 10,000 women not taking this particular preparation: eight more would develop breast cancer, seven more would have a heart attack; eight more would have a stroke and eight more would have blood clots in their lungs. Do these findings prove there are risks? The simple answer is yes. 

But -- and there always seem to be "buts" when it comes to medicine -- there were also some positive outcomes within the same research: five fewer women would have hip fractures and six fewer would get colorectal cancer. 

Moreover, the women in the study may not be representative of the "average" woman who wants to consider using hormone therapy. Their average body mass index was 28, i.e. many were overweight or obese. Most intriguing, is that the study looked at older women (average age 63) who were not suffering from severe menopausal symptoms, so it didn't address the issue of hormone therapy at the onset of menopause when symptoms tend to be most severe. 

More recently, information from an estrogen-only companion study was released. There was no increased risk of breast cancer, but there was an increased risk of stroke in these women (who now were older, often in their 70s) -- 12 per 10,000 women per year of use. This and other studies have made it clear that we should not take estrogen to prevent or treat heart disease or stroke. 

Hormone therapy is not for every woman. If you have heart disease or are at high risk for stroke, coronary vascular disease, breast cancer or have a history of abnormal clot formation, there are other prescribed medications you can consider, such as Anti-depressant and anti-seizure medications. The information on the efficacy of herbs and other supplements for menopausal symptoms has, so far, not been convincing. 

If you have no underlying risk factors for the above and your menopausal symptoms are diminishing your lifestyle, you don't have to grin, bear and sweat! You can (and in my opinion should) consider hormones. The FDA advises that "the lowest amount should be used for the shortest amount of time to reach your treatment goals." 

There are other types of estrogen and progestins than those used in the government study. Their doses vary, allowing use of lesser amounts of hormone. New, non-oral delivery methods such as transdermal estrogen (a patch) and transvaginal estrogen (a ring) now provide steady, low dose levels of estradiol, the form of estrogen made by the ovaries. The decision to take or not to take hormones must be made on a woman to woman basis and the type and dose should be individualized to your health and symptoms. One dose does not fit all. Talk to your physician about what can work best for you.

Editor's Note: The opinions contained in this article are those of the author and do not reflect the opinions of OBGYN.net or it's Editorial Advisors.