Is hormone therapy safe again?
By Harvard Health Letters
What to consider and why
From around 1960 until 2002, doctors often prescribed HT both to treat symptoms of menopause and to protect women from the condition that kills more women than any other: heart disease. Beginning in 2002, reports from a large, well-designed study called the Women's Health Initiative (WHI) suggested that HT increased the risks of heart attack, stroke, dementia, breast cancer, and blood clots in the lungs and legs.
These results understandably led many doctors to discourage HT.
"Nobody expected the results of the WHI, and in some ways we overreacted," says Dr.
There's no doubt that HT helps women deal with the unpleasant symptoms of menopause. But does it protect against heart disease, as doctors believed before 2002, or increase the risk of heart disease, as the WHI found?
The women who participated in the WHI had an average age of 63. For women that age, the risks of heart attack and stroke from HT are real. However, recent studies indicate that HT is protective in women under age 60. For example, a Danish study published in
NEW EXPERT RECOMMENDATIONS
"Ten percent of women get very symptomatic during menopause. They are miserable, and hormones make them feel better," says Dr. Richardson.
WHAT SHOULD YOU DO?
If you have marked menopausal symptoms, are generally healthy, and are 59 or younger, Dr. Richardson suggests you go to a menopause clinic or find a specialist through the
"For example, there are drugs that can help with hot flashes. And remember to dress in layers, sleep in a cool room, and carry a small portable fan with you," says Dr. Richardson.
Q&A with Dr.
Q. Who's a candidate for short-term HT?
A. There's no pat answer. I treat women on the basis of their symptoms, personal health history, and preferences.
Q. Who should not be on HT?
A. The women I worry about most are women with a history or tendency to clot, and women with breast cancer. The jury is still out on every other risk factor.
Q. How long is the short term?
A. The data show that breast cancer risk goes up after four or five years, so most clinicians start to worry about using hormones for more than three to five years. However, it must be individualized.
Q. Are bioidentical hormones safer?
A. No, the people who perpetuate the idea are basing it on theory and on ridiculously old studies. - Harvard Health Letter
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© 2013, PRESIDENT AND FELLOWS OF HARVARD COLLEGE. ALL RIGHTS RESERVED. DISTRIBUTED BY TRIBUNE MEDIA SERVICES, INC.