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Hormone Therapy: A Shift in Thinking

Changes in hormone replacement therapy (HRT)

Over the past decades, hormone replacement therapy (HRT) was thought to offer health- and youth-preserving benefits to postmenopausal women. But certain studies have led to a dramatic shift from this way of thinking.

The Women's Health Initiative (WHI) study has shown that HRT does not protect against heart disease. In fact, in a small number of women who are 10 or more years past menopause, it causes heart disease, including heart attacks.7 In the WHI study, short-term use of HRT was also linked to an increase in the numbers of strokes and blood clots. Using HRT for several years was linked to increased cases of breast cancer and dementia. Overall, most women using HRT in the WHI study had no serious side effects, but they also had no long-term benefits.

Among all women, average hormone therapy risks are very low. Your personal risks may be lower or higher than the average. This depends on your risk factors for breast cancer, ovarian cancer, cardiovascular problems, blood clots, or dementia.

Because of the risks of HRT, many experts recommend that HRT be used for:

  • Short-term treatment of menopause symptoms. HRT effectively relieves menopause symptoms for most women. Women who decide that HRT benefits outweigh their risks are advised to use the lowest effective dose for as short a time as possible.6 For most women, menopause symptoms naturally improve within a few years' time, making long-term symptom treatment unnecessary.
  • Osteoporosis prevention and treatment, in select cases. Most experts recommend that long-term HRT only be considered for women with a high osteoporosis risk. In this case, estrogen's bone-protecting benefit may outweigh the risks of taking HRT. Women are now encouraged to consider all possible osteoporosis treatments and to compare their risks and benefits.
dplink.gif Menopause: Should I Use Hormone Replacement Therapy (HRT)?

Changes in estrogen replacement therapy (ERT)

Women who have early, sudden menopause after a hysterectomy with both ovaries removed are usually advised to use estrogen replacement therapy (ERT) to protect against bone loss. The low estrogen levels of menopause cause bone thinning. Compared to women who are not taking hormone therapy, women taking ERT have fewer hip fractures (a sign of estrogen's bone-protecting effect).10

ERT also helps with menopausal symptoms. Known ERT risks come from studies of women older than 50. It may be that the benefits outweigh the risks for younger women who take ERT until the age of natural menopause. This question needs further research.

The Women's Health Initiative (WHI) studied estrogen-only therapy in older women and found that it increases the risks of blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism) and the risk of stroke during the first year of use.10 ERT may increase the risk of dementia in women who are older than 65.11 ERT offered no protection against heart disease. In fact, it was linked to heart disease and ovarian cancer in a small number of women.7, 12


WebMD Medical Reference from Healthwise

Last Updated: February 23, 2011
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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