The Healthy Heart Handbook for Women
Other Factors That Affect Heart Disease
Menopausal Hormone Therapy: What Every Woman Needs To Know
Menopausal hormone therapy once seemed the answer for many of the conditions women face as they age. It was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life.
But beginning in July 2002, findings emerged from clinical trials that showed this was not so. In fact, long-term use of hormone therapy poses serious risks and may increase the risk of heart attack and stroke.
The findings come from the Women's Health Initiative (WHI), launched in1991 to test ways to prevent a number of medical disorders in postmenopausal women. It consists of a set of clinical studies on hormone therapy, diet modification, and calcium and vitamin D supplements; an observational study; and a community prevention study.
The two hormone therapy clinical studies were both stopped early because of serious risks and the failure to prevent heart disease. One of the hormone studies involved 16,608 postmenopausal women with a uterus who took either estrogen-plus-progestin therapy or a placebo. (The added progestin protects women against uterine cancer. A placebo is a substance that looks like the real drug but has no biologic effect.) The other study involved 10,739 women who had had a hysterectomy and took estrogen alone or a placebo. The estrogen used in the WHI was conjugated equine estrogens (0.625 mg daily), and the progestin was medroxyprogesterone acetate (2.5 mg daily).
In brief, the studies concluded the following:
Estrogen-plus-progestin therapy increased women's risk for heart attacks, stroke, blood clots, and breast cancer. It also doubled the risk of dementia and did not protect women against memory loss.
However, the estrogen-plus-progestin therapy had some benefits: It reduced the risk for colorectal cancer and fractures. It also relieved menopausal symptoms, such as hot flashes and night sweats, in women who suffered from them. But the study found that estrogen plus progestin did not improve women's overall quality of life.
Estrogen-alone therapy increased the risk for stroke and venous thrombosis (blood clot, usually in one of the deep veins of the legs). It had no effect on heart disease and colorectal cancer, and it did not increase the risk of breast cancer. Estrogen alone gave no protection against memory loss, and there were more cases of dementia in those who took the therapy than those on the placebo, although the increase was not statistically significant. Estrogen alone reduced the risk for fractures.
The research showed that both types of medication—estrogen alone and estrogen with progestin—increased the risk of developing urinary incontinence, which is the inability to "hold in" urine. For women who already have the condition, these medications can worsen symptoms.
If you are currently on or have taken menopausal hormone therapy, the findings can't help but concern you. It is important to know, however, that those results apply to a large group of women. An individual woman's increased risk for disease is quite small. For example, each woman in the estrogen-plus-progestin study had, on average, an increased risk of breast cancer of less than one-tenth of 1 percent per year.
While questions remain, these findings provide a basis for some advice about using hormone therapy:
- Estrogen alone, or estrogen plus progestin, should not be used to prevent heart disease. Talk with your doctor about other ways of preventing heart attack and stroke, including lifestyle changes and medicines such as cholesterol-lowering statins and blood pressure drugs.
- If you are considering using menopausal hormone therapy to prevent osteoporosis, talk with your doctor about the possible benefits weighed against your personal risks for heart attack, stroke, blood clots, and breast cancer. Ask your doctor about alternative treatments that are safe and effective in preventing osteoporosis and bone fractures.
- Do not take menopausal hormone therapy to prevent dementia or memory loss.
- If you are considering menopausal hormone therapy to provide relief from menopausal symptoms such as hot flashes, talk with your doctor about whether this treatment is right for you. The WHI did not test the short-term risks and benefits of using hormone therapy for menopausal symptoms. The U.S. Food and Drug Administration recommends that menopausal hormone therapy be used at the lowest dose for the shortest period of time to reach treatment goals.
And remember, your risk for heart disease, stroke, osteoporosis, and other conditions may change as you age, so review your health regularly with your doctor. New treatments that are safe and effective may become available. Stay informed. If you have heart disease, see Menopausal Hormone Therapy.
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Last Updated: February 29, 2012