HRT & Alternatives

Last Updated: Oct. 1, 2003

Deciding whether to use hormone replacement therapy (HRT) after menopause is a difficult decision many women face. Research has shown that HRT is very effective for relieving menopausal symptoms such as hot flashes and vaginal dryness. It can also reduce the risk of osteoporosis.

However, there are also known health risks and uncertainties about long-term use. Recent research has demonstrated that long-term use of estrogen in combination with progestin results in more risks than benefits.

HRT study stopped
On July 9, 2002, the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health announced that they would stop a major clinical study of the type of postmenopausal hormone therapy in which estrogen is combined with progestin.

The study, a part of the Women’s Health Initiative, found increases in breast cancer, cardiovascular disease, stroke, and blood clots in study participants who were taking estrogen plus progestin compared to women taking placebo pills.

There were noteworthy benefits of estrogen plus progestin, including fewer cases of hip fractures and colon cancer, but on balance the harm was greater than the benefit.

Considering alternatives
Many women may now be considering using alternatives to conventional HRT to relieve menopausal symptoms and to lower the risk of conditions such as osteoporosis and heart disease.

More than 30% of women use acupuncture, natural estrogen and herbal supplements. At this time, there is not enough scientific evidence to determine whether these therapies are beneficial. In addition, we do not have sufficient information to show whether these therapies are as safe or safer than conventional drugs being used for menopausal symptoms, osteoporosis, or heart disease.

Botanical products containing or acting like estrogens may provide some of the benefits of estrogen in relieving menopausal symptoms. For example, studies have suggested that soy food products can benefit women with mild hot flashes.

Current research continues on several botanicals including black cohosh, red clover, hops, dong quai, flax seed, and dietary soy.

Postmenopausal women should consult their health care provider about their personal risks and benefits of using HRT, as well as the use of alternative therapies. Certain lifestyle changes including quitting smoking, eating well, and exercising regularly can also offer benefits and should be considered for promoting healthy aging and reducing the risk of heart disease.

Alternative therapies may or may not be helpful in relieving menopausal symptoms. The cost of alternative therapies such as dietary supplements is usually not covered by insurance. More research is needed to define the benefits and risks.

Herbal therapies may have adverse side effects or exhibit harmful interactions with other medications. Women should always discuss their use of herbs and dietary supplements with their health care provider.

Source: National Heart, Lung and Blood Institute

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