HRT: Where Are We Now?
Is hormone therapy (HRT) making a comeback?
Putting the Risks of HRT in Perspective
Media reports on the WHI results may have given people inflated fears of
hormone replacement therapy's risks, the doctors say.
For example, the Women's Health Initiative results showed that combined
hormone replacement therapy seems to increase the risk of breast cancer by 33%,
Schiff says. That's a serious increase. Still, the risk to any one woman is not
as high as it sounds, Schiff says.
"According to the WHI, without hormone therapy, 3 of every 1,200 women aged
55 to 59 will develop breast cancer this year," says Schiff. "With hormone
therapy, 4 out of 1,200 will. It's a 33% increase, but the absolute risk is
still very, very small."
Shuster points out that other behaviors -- like drinking two glasses of wine
a night -- also increase breast cancer risk by a similar amount.
Women who take estrogen alone -- a treatment only available to people who
have had a hysterectomy -- appear to have a lower risk of developing breast
cancer than women who take progestin and estrogen together. In a 2006 JAMA
article, researchers from the Women's Health Initiative found that after about
seven years of treatment with estrogen, there seemed to be no increased risk of
However, estrogen-only therapy may have long-term risks. A May 2006 study
published in the Archives of Internal Medicine found using
estrogen-only therapy for 20 years or more showed increased risk of developing
So Who Needs Hormone Replacement Therapy?
As HRT is being re-evaluated -- and new evidence is coming in -- it's
difficult to know who should get hormone replacement therapy and for how
The U.S. Food and Drug Administration (FDA) recommends that HRT should be
used in women who have severe menopausal symptoms.
"Estrogens are the best agents we have for the relief of menopausal symptoms
like hot flashes, vaginal dryness, and loss of sexuality," says Schiff. They're
also a good treatment for menopausal symptoms that are often not recognized:
Difficulty sleeping, stiffness, joint pain, and mood changes.
But for disease prevention -- lowering the risk of heart attacks, strokes,
and most cases of osteoporosis -- the FDA still does not recommend hormone
"We have other ways of cutting the risks of heart attacks and strokes,"
Schiff tells WebMD, including better diet, exercise, and other medicines.
Will HRT ever again be used as prevention for these serious diseases? Only
time and research will tell. The experts remain divided.
"I believe that studies in the next few years will support using hormone
therapy in younger women [closer to the onset of menopause] for prevention,"
says Shuster. "But "we don't have all the information yet."