HRT: First safe, then risky...now safe?

05. May 2011

What’s a woman to do? Honestly, when it comes to hormone replacement therapy (HRT), you need a scorecard to keep up! The latest? You may want to start popping that Premarin again because new research finds HRT may be a good thing for women entering menopause.

That news may be hard to swallow for tens of thousands of women who quit the hormone treatment back in 2002. I’ll never forget reporting on the high profile study that found estrogen therapy led to heart problems and strokes. The news caused such fear and panic, you could almost hear the collective “whoosh” as women frantically flushed their estrogen pills down the toilet.

So, what’s changed? After reviewing dozens of studies on HRT, the International Menopause Society (IMS) now concludes the original study was flawed. In fact, in a statement presented at a conference in Madrid, the IMS announced, “Hormone replacement therapy remains the first-line and most effective treatment for menopausal symptoms.”

Some doctors are skeptical, even angry about the statement insisting the Society’s conclusions are misleading and dangerous to the health of women worldwide.

What are the rest of us to make of this? What about the millions of women suffering from postmenopausal symptoms… many not sure whether to continue their HRT, restart a regimen they stopped or begin as they enter menopause? 

Maybe we should back up a bit. The use of hormone replacement therapy dates back decades… women taking doses of estrogen, sometimes supplemented by progestin, in order to relieve the unpleasant symptoms of menopause. For years, women depended on the regimen to give them relief from severe hot flashes and night sweats.

But in 2002, everything changed. Researchers cut short the much-publicized Women’s Health Initiative study of HRT… citing concerns over health problems. But many doctors felt the recommendation to stop HRT all together went too far, discouraging women they felt really needed the treatment.

The recent IMS statement may just convince women frightened about taking estrogen therapy. Dr. Tom Felger of Indiana University’s School of Medicine says, “I think this document is trying to moderate the craziness that came out on the public side of the original recommendations.” Advocates of HRT are opposed to the “all or nothing” approach… that for symptomatic, menopausal women, HRT is very effective and safe. 

So, again, what’s a woman to do? With the newer, more encouraging news about HRT… many doctors are once again prescribing estrogen replacement. They’re just being a little more specific in their approach. For newly menopausal women suffering sleepless nights and miserable days due to hot flashes, the benefits of hormone therapy are likely to outweigh the risks. However, according to one of the IMS investigators, Dr. JoAnn Manson, “low doses should be used for the shortest time necessary… usually less than four to five years.

While the controversy continues, I’ll keep taking my hormone replacement. But you better believe, I’ll be keeping an eye on the results of the next study. Stay tuned! 

***NOTE: For women at high risk for breast cancer, there is a link between HRT and the higher incidence of breast cancer. As always, before taking any medication or supplement, be sure and discuss the pros and cons with your doctor. 
 

Contact Carol by emailing her at Carol@palomarhealth.org.