Prescriptions for hormone replacement therapy (HRT) have yet to recover from a hit by the Women’s Health Initiative (WHI) in 2002. That’s when the WHI rocked the medical community with their findings that combined progestin/estrogen therapy was not just ineffective, it was dangerous too, with higher risk of breast cancer, stroke and heart disease linked to the treatment.
A 2008 follow-up study published in the Journal of the American Medical Association didn’t help. Researchers in that study found women who quit combination HRT three years previously had lower risk of heart disease, but were more vulnerable to stroke, blood clots and cancer.
And yet, you’re probably most familiar with HRT as a treatment for menopause symptoms. You may be disappointed with that too – a Finnish study published in November found that HRT only helped menopause symptoms in women with hot flashes.
It’s your choice whether you pursue HRT for menopause symptoms. You’ll want to make that decision with your doctor and weigh the pros and cons of the treatment along with your medical history and the risks involved.
Hormone replacement therapy is available as:
Estrogen Therapy – Estrogen taken by itself, as a pill, patch or cream. Doctors typically prescribe a low dose of estrogen therapy at the lowest dose to relieve menopause symptoms.
Progesterone/Progestin-Estrogen Hormone Therapy – Sometimes called ‘combination therapy’, this combines estrogen with a synthetic form of progesterone, called progestin. Note that some women might also require estrogen and a lower dose of progesterone to prevent the monthly bleeding that can occur with combination HRT.
HRT is synthetic estrogen and progesterone. It’s designed to ease the transition as the ovaries produce less of these quissentially female hormones and to bring relief from menopause symptoms.
Estrogen helps keep the vagina healthy, regulates calcium and maintains healthy cholesterol levels in the blood. So it’s no surprise that hot flashes and bone loss are both associated with this biological event.
HRT can make a difference for many women. A new study published in the journal JAMA Ophthalmology found that women who took estrogen-only therapy for menopause symptoms might also reduce their risk of the eye disease glaucoma.
This was the first study to explore the link, according to lead researcher Dr. Joshua Stein, who published the findings on review of insurance claims from women who’d enrolled in a managed care plan for at least four years. Each woman had visited an eye care provider at least twice between 2001-2009.
Stein evaluated information from more than 152,000 women, roughly 60,000 of whom had at least one estrogen-only pill prescription. The other women took a combination of estrogen and progesterone or estrogen and an androgen (male sex hormone).
During the study period, about two percent of the women developed primary open angle glaucoma. The latter is a common disease that develops when pressure builds in the eye. And glaucoma is an umbrella term for a group of eye diseases that damage the optic nerve and can lead to blindness.
Risk of glaucoma went down 0.4% each month the women used estrogen-only pills. Four years later, risk was reduced by about 19%.
The mechanism of action is unclear, but the researchers theorize estrogen might reduce pressure or protect certain cells in the eye. Observers point out too that the study does not prove a cause and effect between estrogen and sight protection. Nor was there a link between glaucoma prevention and other hormones. It did not suggest women should pursue estrogen HRT to protect their vision.
The study, though encouraging, merely shows there is a link between estrogen and lower risk of glaucoma. And that drug companies might explore this connection further to develop a glaucoma treatment in the future.
While HRT might work for some women, it could be a waste of time for others. A study published in November of last year found that hormone replacement therapy for menopause only worked if the patient experienced hot flashes among her symptoms.
The study, published November 13 in the online journal Menopause, consisted of 150 women who’d recently been through menopause. Seventy-two of those women had at least moderate to severe hot flashes daily. The remaining 78 had three or fewer mild hot flashes, or none.
Current evidence leans to younger women, between 50 and 55, or those who start HRT within ten years of menopause, as getting the most benefit out of hormone treatment.
Half of the women in each group took various kinds of HRT for six months. The other half took an inactive placebo with no hormones.
When the study ended, the women with problematic hot flashes who took HRT had fewer menopause symptoms, including memory loss, insomnia, concentration anxiety and irritability. Notably, though, HRT did not help women without hot flashes of more frequency and intensity.
Observers say the study was well-designed. It shows clear evidence that HRT does not improve quality of life in menopausal women without hot flashes. And when factoring in the WHI’s findings and risks involved with the treatment, it might not be worth the trouble.
Hormone replacement therapy appears to benefit women with hot flashes among their menopause symptoms. The studies suggest it should not be used to mask underlying health issues or address specific concerns. Among those are:
Mental Focus – A study published in the Proceedings of the National Academy of Sciences found that low estrogen was not responsible for mood swings and poor memory in women post menopause.
Heart Disease – The WHI study found that HRT did not lower rates of cardiac events in post-menopausal women with documented heart disease. In fact, it increased risk of heart disease in women taking estrogen-only or estrogen-progestin HRT.
Osteoporosis – Women concerned about bone loss should speak with their physician and weigh the benefits of HRT with the WHI’s findings. Higher calcium intake might help, along with alternative treatments for osteoporosis and bone fractures.
Breast Cancer – Studies continue into the link between HRT and breast cancer. Women should continue with their schedulled mammograms and do self-breast exams too.
The Women’s Health Initiative study and follow-up research document the risks of HRT. These include:
Higher Risk of Endometrial Cancer – For a patient who still has her uterus. Progesterone must be taken with estrogen in this scenario.
Increased Risk of Blood Clots and Stroke
Greater Risk of Breast Cancer – This applies to women who take estrogen-progestin HRT.
Chance of Heart Disease – The Women’s Health Initiative found that estrogen-progestin treatment increased risk of heart disease. This might vary, however, with higher risk to older women, and lower risk to women just starting menopause.
Note too that some women should not pursue hormone therapy – it’s not recommended for women with:
Women who are pregnant, or who might be pregnant, should not do HRT. Smokers should quit cigarettes before doing hormone therapy.
Know the risks of hormone therapy, and measure them according to what you expect out of the treatment. Research continues into HRT – and it’s likely the debate surrounding the risks will go on for some time.
The current evidence leans to younger women, between 50 and 55, or those who start HRT within ten years of menopause, as getting the most benefit out of hormone treatment. If used short-term, and with a low dosage, it should be fine for women with a clear bill of health.
Having said this, it’s hard to ignore the rumblings of breast cancer. Studies are inconclusive, but the link is there. If that’s enough to point you in the direction of alternative menopause treatment, we’re all for it.
Speak to your doctor if you want to do hormone replacement therapy. He’ll factor in your medical history, along with your lifestyle habits, like whether you smoke or drink, and your diet, current weight and blood pressure.
The decision is yours, but remember, hormone therapy is just designed to ease the transition through menopause. It’s not meant to prevent disease or specific health concerns. So live well, speak with your doctor, and proceed with care regarding hormone replacement therapy.
You can also try alternative menopause treatments. That could be a vaginal estrogen cream, for example, which should reduce vaginal tissue thinning. Consider a natural enhancement gel, too, like Vigorelle, or Provestra. The latter is a natural libido supplement for women with black cohosh root – a popular herb used in North American to reduce hot flashes and dryness.
Other alternative menopause symptoms include:
Estrogen-rich foods: Some evidence links soy to fewer hot flashes. Studies are mixed, but soy-rich foods, including soy milk, soy bean, nuts, seeds and parsley, among others, might be worth a try. Barring food allergies, of course.
Increase calcium intake: Women at 50 or beyond should get 1,200mg of calcium each day, whether through diet, supplements, or both. Do weight training too, with resistance training to strengthen bones and lower risk of osteoporosis.