The answer depends on how long you've been taking hormone replacement therapy, or HRT, and why. Several studies have shown both benefits and risks of HRT.
The Women's Health Initiative, a 15-year study conducted by the National Institutes of Health with postmenopausal women -- found that long-term use (five or more years) of hormone replacement therapy combining two hormones, estrogen and progestin, increased women's risk of heart disease, stroke, blood clots, and breast cancer. However, the study found that HRT lowered women's risk of bone fractures and colorectal cancer.
To analyze the findings in numbers:
If 10,000 women were taking hormone replacement therapy for a year and 10,000 women were not taking HRT, in the HRT group eight more women would develop invasive breast cancer, seven more would develop heart disease, eight more would have a stroke, and eight more would develop blood clots. There would also be six fewer colorectal cancers and five fewer hip fractures.
The WHI study was somewhat undermined by another study published in 2006 in the The Journal of Women's Health that showed that the risk of heart disease demonstrated in the WHI was related more to the advanced age of the participants as opposed to the HRT. The study also found that HRT given to younger women, at the onset of menopause, appeared to decrease the risk of heart disease.
Still another study, published in 2006 in Archives of Internal Medicine, looked at nearly 11,000 women aged 50 to 79 taking only estrogen. Researchers reported no overall difference in heart attack risk among women who took HRT and those who did not. In addition, there appeared to be a lower overall risk of heart disease in the women who began taking the estrogen between the ages of 50 and 59, suggesting a heart-healthy benefit to beginning the therapy at a younger age.
Finally, a study published in the March 5, 2008, issue of the Journal of the American Medical Association reported on WHI participants three years after they stopped combination HRT. The researchers found that "many of the health effects of hormones such as increased risk of heart disease are diminished, but overall risks, including risks of stroke, blood clots, and cancer, remain high." The study also concluded that the increased risk of breast cancer appears to linger and "other effects of combination hormones, such as decreased risk of colorectal cancer and hip fractures, also stopped when therapy ended."
The U.S. Preventive Services Task Force (USPSTF), a panel comprised primarily of physicians, considered the accumulated scientific evidence on HRT and issued recommendations in 2005. Among them: The use of combination HRT or estrogen-only HRT may slightly lower risk of bone fractures and colorectal cancer, but has no beneficial effect on heart disease. In fact, the use of either combined estrogen-progestin might lead to a higher risk of breast cancer, blood clots, stroke, cholecystitis and dementia, the task force found.
The USPSTF also concluded that estrogen-only HRT might raise the risk of blood clots, stroke and dementia.
The harmful effects of hormone replacement therapy, the task force concluded, outweigh their benefits.
How does this information relate to your personal decision about menopause and hormone replacement therapy? Every woman is unique, and no one should start or stop HRT without consulting with her doctor. That said, here are some facts that may help you and your doctor arrive at a decision.
Menopause: Not all women experience symptoms such as hot flashes, night sweats, or mood swings during menopause. Those who do usually have the symptoms for just a few years. So, don't panic if you need hormone replacement therapy to ease menopause symptoms for a year or two. Most experts today say the benefits of hormone replacement therapy outweigh the risk if hormones are taken for a brief period of time. But if you have been on hormone replacement therapy for several years, or if you started HRT before ever experiencing bothersome symptoms, consider talking with your doctor about tapering off the hormones. You may be surprised. The menopause symptoms you dread may not affect you at all.
Heart Disease: Women taking standard hormone replacement therapy (Prempro, Premphase, Femhrt, and Activella) to prevent heart disease should talk with their doctors about gradually discontinuing the medication. The latest research clearly indicates that hormone replacement therapy does not prevent heart disease. So why did we ever begin prescribing hormone replacement therapy to prevent heart disease? The practice began because observational studies found that women taking hormone replacement therapy tended to have lower rates of heart disease, stroke, colon cancer, and osteoporosis. It now appears, at least in terms of cardiovascular disease, that these women may simply have been healthier and more likely to see a doctor.
Osteoporosis: Research shows that hormone replacement therapy does lower a woman's risk of bone fractures. If you are taking hormone replacement therapy to prevent osteoporosis, discuss your family history and treatment options carefully with your doctor. Questions to consider include:
Is your risk for osteoporosis significantly greater than your risk for heart disease or breast cancer? What other treatments could preserve bone health as well as hormone replacement therapy without the risk? What lifestyle changes (such as diet and weight-bearing exercise) could preserve your bone health? The U.S. Preventive Services Task Force
If you choose to stop hormone replacement therapy, taper off the hormones gradually. Some women suffer symptoms of withdrawal if they stop abruptly. For example, Laura Corio, MD, author of The Change Before the Change, recommends her patients taper off by taking the hormones every other day for two weeks, and then stopping completely.
If you choose to stay on hormone replacement therapy, ask your doctor to re-evaluate you once a year to look at risk vs. benefits. Remember, hormones are strong drugs. Staying on hormones longer than five years is no longer advisable.