Weigh Risks and Benefits of HRT

Posted: Oct. 1, 2004

Whether you go through menopause naturally or surgically, symptoms can result as your body tries to adjust to the drop in estrogen levels. These symptoms vary greatly – one woman may breeze through menopause with few symptoms, while another has difficulty. Symptoms may last for several months or years, or persist. The most common symptoms are hot flashes or flushes, sweats, and sleep disturbances.

Progestin and estrogen
To relieve the symptoms of menopause, doctors may prescribe postmenopausal hormone therapy. This can involve the use of either estrogen alone or with another hormone called progesterone, or progestin in its synthetic form. The two hormones normally help to regulate a woman's menstrual cycle. Progestin is added to estrogen to prevent the overgrowth (or hyperplasia) of cells in the lining of the uterus. This overgrowth can lead to uterine cancer.

If you haven't had a hysterectomy, you'll receive estrogen plus progestin therapy; if you have had a hysterectomy, you'll receive estrogen-only therapy. Hormones may be taken daily (continuous use) or on only certain days of the month (cyclic use).

Recent studies found risks and benefits
In 1991, the National Heart, Lung and Blood Institute (NHLBI) and other units of the National Institutes of Health (NIH) launched the "Women's Health Initiative" (WHI), one of the largest studies of its kind ever undertaken in the United States. It consisted of a set of clinical trials, an observational study, and a community prevention study, which altogether involved more than 161,000 healthy, postmenopausal women.

The study was to have continued until 2005. However, it was stopped in July 2002 because the Data and Safety Monitoring Board (DSMB) found an increased risk of breast cancer and that, overall, risks from use of the hormones outweighed and outnumbered the benefits. "Outnumbered" means that more women had adverse effects from the therapy than benefited from it.

The key adverse effects of the postmenopausal hormone therapy were more cases of breast cancer, heart attacks, strokes, and blood clots.

The main benefits were fewer hip and other fractures and fewer cases of colorectal cancer.

Talking with your doctor
It's important to be involved in your health care. Ask questions and express your concerns. Here are some questions that may help you talk with your health care provider about hormone therapy:

• Why am I taking hormone therapy? Or why should I take hormone therapy?
• Which hormone therapy am I on?
• What are my risks for heart disease, breast cancer, and osteoporosis?
• Should I stop taking the hormone therapy?
• What's the best way for me to stop? What side effects will I have?
• Is there an alternative therapy that I can use long-term?
• What alternatives can help me prevent heart disease?
• What alternatives can help me prevent osteoporosis?
• What can I do to keep menopausal symptoms from returning?

Your risk for heart disease, osteoporosis, and colorectal cancer may change over time. So remember to regularly review your health status with your doctor or other health care provider.


It's also important to bear in mind that your doctor or other health care provider may not be able to answer all of your questions — many questions about postmenopausal hormone use remain. For instance, it's not yet known if increases in disease risk caused by long-term use of estrogen plus progestin drop after use stops.

As with any treatment, you need to carefully weigh your personal risks against the possible benefits and make the best choice possible for your health and lifestyle needs.

Source: National Heart, Lung and Blood Institute

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