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Oct 09, 2013

Hormone Therapy: Do Risks Outweigh the Benefits?

Study advises against use of hormone therapy for chronic disease prevention, as it may increase long-term health risks.

For women going through menopause, hormone therapy often helps minimize symptoms like hot flashes and night sweats. But according to research assessing the long-term impacts of estrogen therapy, the risks from taking these drugs may far outweigh the benefits.

A study called the Women’s Health Initiative trial enrolled more than 27,000 postmenopausal women between 1993 and 1998 to quantify the risks and benefits associated with hormone therapy. At that time, we knew that hormone therapy treats symptoms of menopause and as many as 40% of postmenopausal women were on some form of estrogen therapy. Some studies also suggested that hormone therapy may help prevent chronic disease, like heart disease and breast cancer. But at the same time, we knew that like all drugs, hormone therapy carries some risk of complications and side effects. And we had little data on the long-term impact hormone therapy may have on women’s health—until now.

After following participants in the Women’s Health Initiative for as long as 13 years, researchers found that in general, hormone therapy does not help prevent chronic disease. Researchers tested two of the most common hormone therapies—conjugated equine estrogens or conjugated equine estrogens plus medroxyprogesterone acetate—and both increased risk of stroke, blood clots, gallstones and urinary incontinence. However, there were a few distinctions between these two therapies.

Compared to women taking no menopause drugs at all, women on the combination therapy had increased risk for heart disease and breast cancer (although only the association with breast cancer was considered statistically significant), while risk was lower among women taking only conjugated equine estrogens. Authors also note that risk of complications did decrease years after taking these therapies and taking conjugated equine estrogens, alone, carried less risk of complications, especially in younger women.

So what do researchers suggest based on these findings? First, neither therapy should be used alone for chronic disease prevention. Data shows that hormone therapies fail to reduce risk of chronic disease and may actually increase risk in some women. Second, investigators believe that the risks of taking the combination therapy (conjugated equine estrogens plus medroxyprogesterone acetate) outweigh the benefits at any age. However, conjugated equine estrogens appear to be a better option, carrying greater health benefits and fewer risks. Study findings also suggest using caution when considering hormone therapy in older women, as risk of complications may be greater in this population.

It’s clear that more research is needed to further understand the risks and benefits associated with hormone therapy. More than anything, these findings reinforce the need for women considering hormone therapy to discuss treatment options with their doctor. All drugs carry certain risk of complications and it’s important to weigh the risks and benefits before deciding which treatment is right for you.

Questions for You to Consider

  • Why do some women take estrogen during menopause?
  • The estrogen in hormone therapy is used by some postmenopausal women to increase estrogen levels. This helps prevent osteoporosis and perimenopausal symptoms, such as hot flashes and sleep problems.
  • Is estrogen therapy safe?
  • Like all medications, oral estrogen therapy can cause certain side effects such as headaches, nausea, and weight gain. In rare cases, oral estrogen can cause more serious side effects. It’s important to discuss safety concerns with your doctor before taking any drugs.

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