In 2002, hormone therapy for menopause symptoms suddenly changed
It’s not surprising that many women approaching menopause are concerned about the safety of hormone therapy. That’s because in 2002, a large clinical trial called the Women’s Health Initiative (WHI) reported that hormone replacement therapy — or HRT — was related to increased risk of breast cancer.
Almost overnight, more than 60% of women stopped taking HRT. Since then, women have hesitated to get hormone treatment for their menopausal symptoms.
You may not know that in the last 20 years, many additional studies and publications have revised this information. This includes re-analysis of the WHI study results as well as new studies on better hormone preparations.
Review of the Women’s Health Initiative trial reverses interpretation of results
The Journal of the American Medical Association recently published a review article reversing the original conclusion, in line with several other analyses of the clinical trial. The authors report that the benefits of hormone therapy in early menopause to combat menopausal and vasomotor symptoms support initiation of hormone therapy before age 60 years for women without contraindications to hormone therapy.
Dr. JoAnn Manson, the lead author of the review article and Chief of Preventive Medicine at Brigham and Women’s Hospital, told NPR, “Among women below the age of 60, we found hormone therapy has low risk of adverse events and [is] safe for treating bothersome hot flashes, night sweats and other menopausal symptoms.”
Important differences between the WHI study and modern HRT
Menopausal hormone therapy typically consists of adding hormones to replace those that declined due to menopause. This includes estradiol, progesterone, and sometimes testosterone. There are numerous formulations of each hormone, with varying doses, effects, and risks. The WHI used oral conjugated equine estrogens (called CEE) which is produced from pregnant horse urine. The progestogen used was medroxyprogesterone acetate. Progesterone is added to estrogen therapy to protect the endometrium of the uterus, but women without a uterus may receive estrogen alone.
We now know that the type of progesterone used in the WHI study is particularly problematic. It was the link to the increased breast cancer risk in early studies. Physicians no longer prescribe this type of progesterone. Instead, they use micronized progesterone — a bioidentical hormone that does not increase breast cancer risk.
Oral CEE has also been related to a higher risk of stroke. Today, transdermal bioidentical estradiol is prescribed to most women. It is available as a patch and is absorbed through the skin. Since it is not metabolized in the liver like oral estrogen, it does not result in increased stroke risk.
Menopause hormone therapy for health
The review paper concluded that the WHI clinical trial results do not support hormone therapy with oral CEE alone or with medroxyprogesterone acetate for postmenopausal women to prevent cardiovascular disease, dementia, or other chronic diseases. However, more recent research studying modern HRT has reported that HRT may improve lifelong health.
For example, research has found that estrogen therapy decreases heart disease, hip fractures, and dementia. The benefits of HRT after breast cancer also outweigh the risks for many women. Low-dose transdermal vaginal estradiol can help to reduce the urinary and vaginal effects of menopause without affecting breast cancer recurrence.
Initial research on testosterone therapy in women indicates that it can provide a variety of health benefits. It can improve sexual function and urinary tract health, bone density, muscle mass, mood, energy, and cognitive function. More study is called for on this promising treatment regimen.
For more information on HRT, visit our Hormones for Menopause page and the website Hormonally. See our other menopause-related blog posts here.
