Hormone Therapy for Women: Neither All Good or All Bad

Tuesday, March 10, 2009

ROCHESTER, Minn. — When it comes to hormone therapy, the pendulum continues to swing. It's not swinging to all good or all bad as it has seemed to in the past. Its role in women's health is somewhere in the middle, according to a Special Report on Hormone Therapy, a supplement to the March issue of Mayo Clinic Women's HealthSource.

The Special Report covers the history of this therapy, risks and benefits, current uses, hormone substitutes, alternative therapies and new directions in treatment and research.

Among the report's highlights:

A history of good and bad: In the 1980s and 1990s, doctors freely prescribed hormone therapy to relieve menopause systems and to help prevent heart disease and osteoporosis. In 2002, a large study called the Women's Health Initiative (WHI) found that older women taking estrogen plus a synthetic form of progesterone (progestin) had a small but increased risk of heart disease, stroke, breast cancer and blood clots. Because of this research, many women discontinued hormone therapy.

Still effective for menopause symptom relief: Hormone therapy remains one of the most effective treatments for severe menopausal symptoms. Most experts consider it a safe and reasonable option for women with troublesome symptoms.

Dosage and delivery methods to reduce risks: Doctors now advise using the lowest effective dose for the shortest amount of time to manage symptoms and minimize risk. Several drug delivery options other than pills may be effective and safer. For example, direct application of a very low dose of estrogen cream can relieve vaginal dryness while minimizing widespread side effects.

Age might matter: Although estrogen therapy is no longer recommended to prevent serious conditions such as heart disease, there's some evidence that it may offer benefits for women who take it early in menopause. In a secondary analysis of WHI trials, women between the ages of 50 and 59 who took estrogen and progestin or estrogen alone had no increased risk of heart attack. And, it appears that women who started hormone therapy within 10 years of menopause tended to have a reduced risk of heart disease.

Be wary of "safe" substitutes: Bioidentical hormones are made from plant sources and once processed, are chemically identical to hormones made in the body. They have been promoted as safer and more effective than traditional hormone therapy. However, with no evidence that this is true, it should be assumed that bioidentical hormones have the same risks as conventional hormone therapy.

No "one size fits all:" With hormone therapy, there is no single approach that's right for all women. It takes a conversation with a doctor to discuss personal health history, potential risks and benefits and other treatment options to determine if hormone therapy is the right choice.

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