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    A Fresh Look at Hormone Therapy

    Women Who Need It Should Take It, Experts Agree, but at Low Doses

    It's OK to Stay on Hormone Therapy continued...

    New evidence from the WHI trial also suggests that the increase in breast cancer risk associated with hormone therapy is limited to estrogen plus progesterone combination treatment. Estrogen alone is recommended for women who have had hysterectomies, while estrogen plus progesterone is recommended for those who still have their uterus.

    Utian says this finding needs to be confirmed but it is increasingly clear that the increase in breast cancer risk with any form of hormone therapy is very small.

    "It is pretty clear that with five years of use or less there is no statistical increase in risk," he tells WebMD. "Beyond five years of use there may be a slight increase, but it is not major."

    While the updated report continued to recommend hormone therapy at the lowest effective dose for the shortest duration possible, Utian says the emerging data on its use is reassuring.

    "Many women who discontinue therapy have their symptoms recur, and we want to reassure them that it is OK to go back on this treatment and stay on it as long as they need to as long as they continue to be monitored by their doctors."

    Other Voices

    The NAMS report comes less than a week after the nation's largest group of women's health doctors issued its own recommendations on hormone therapy. The American College of Obstetricians and Gynecologists (ACOG) task force also took aim at alternatives to traditional hormone therapy, concluding that natural treatments such as yam extract, black cohosh, and red clover are not effective for relieving menopausal symptoms.

    The ACOG report noted that roughly 10% of menopausal women continue to have symptoms for more than four years. The group agreed with the NAMS finding that long-term treatment is appropriate for these women.

    In a news release, ACOG task force chairman Isaac Schiff, MD, noted that roughly 65% of women on hormone therapy stopped after the WHI findings were published three years ago but a quarter of these women later changed their minds and went back on the treatment.

    "[ACOG] is moving back to an appropriate balance -- accepting that hormone therapy has risks, but recognizing that it can be appropriate for conditions like hot flashes so long as women are informed about their risks and weigh their decision with their doctor," Schiff says.

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