How Safe is Hormone Replacement Therapy? A Leading Expert Sums Up What We Now Know

More than a decade after the Women’s Health Initiative (WHI) was abruptly halted three years early, due to a high rate of breast cancer and heart disease among women taking combined estrogen and progestin hormones, many women are still concerned about the safety of hormone replacement therapy, choosing instead natural remedies that only help some women, some of the time.

Medical researchers have continued to parse and analyze the WHI findings and much more has been learned about when hormone therapy is most effective and for whom. But is it safe for most women? Or do the risks outweigh the benefits?

To explain what we now know about the safety of hormone use during menopause, I spoke with Dr. Margery Gass,  Executive Director of The North American Menopause Society.  Here’s a transcript of our conversation.

What do we now know about hormone safety, a decade after the WHI study was halted?

North American Menopause Society, menopause, hot flashes, hormone therapy, hormone safetyDr. Gass: Right now, we believe that hormones are relatively safe for most healthy women who are being bothered by hot flashes or menopausal symptoms in general. They do carry small risks but so do most things that are prescription drugs and even some over-the-counter products like aspirin, which has potential for GI bleeding and hemorrhagic stroke. So most medications do have risks, and now women can be aware of the small risks associated with hormone therapy and have some idea of whether their symptoms justify using hormones.

It’s really about individualized decision making, isn’t it?

Dr. Gass:  It’s really important to know what a woman’s health care priorities are. For example, if her number one priority is preventing osteoporosis, and not becoming stooped over the way her mother did, and she’s having hot flashes, she would get benefits for both these concerns by taking hormone therapy. That might be very attractive to her.

On the other hand, if she’s a woman whose primary concern is avoiding breast cancer, she may prefer to put up with a few hot flashes, rather than encounter a small increased risk of breast cancer with hormones.

It seems that we’ve come a long way in our understanding of the risks of hormone therapy, especially during the last decade.

Dr. Gass: There was a time back in the late 1990s, when it was expected that physicians would discuss the option of hormone therapy with every menopausal woman, whether she was having symptoms or not. Now we have a more balanced approach. Use hormone therapy for conditions that are truly bothering you.

Is it considered safe to be on hormone therapy for more than five years?

Dr. Gass: Again, it’s going to depend on your healthcare priorities. The five year time point was when the increased risk of the breast cancer first appeared in the WHI study. That doesn’t mean that a woman can’t use hormones if she’s miserable with hot flashes. She just should be aware that there is a small, increased risk of breast cancer.

Can you put that level of risk in perspective for us?

Dr. Gass: There are a number of things we do that can increase our risk of breast cancer a little bit. Alcohol consumption and being over-weight are two examples. Having a late menopause can also increase the risk of breast cancer compared to your friend who had an early menopause. There are data that show women who have had an early puberty and a late menopause have more breast cancer than women who were exposed to their own estrogen a shorter amount of time.

Taking hormones has a similar risk. It increases your risk of breast cancer about as much as having your own natural menopause a couple of years later. It’s a small risk and it all depends on how much that matters to individuals.

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To Readers – I’m curious. What’s your take on this? Does this information make you relieved, or more concerned, about hormone use?  And, if you’ve decided not to use hormones, what has helped to alleviate menopausal symptoms?  I’d love to hear from you in the comment box below.

Here are some reading recommendations if you’d like to know more:

“Hormone Use Benefits May Trump Risks: Age Matters”  - Wall Street Journal June 4, 2012

Initial Findings of the KEEPS Trial (Kronos Early  Estrogen Prevention Study) Oct, 2012

Dr. Susan Love’s Menopause and Hormone Book