The Latest Information on Hormone Therapy
In October, the American
College of Obstetricians and Gynecologists issued the most comprehensive report
available regarding hormone treatment (HT) for women. The report delineates the
risks, benefits and still-unanswered questions about HT.
More than two years ago, in
the summer of 2002, the Women’s Health Initiative issued a landmark study
showing that estrogen plus progestin is effective for the temporary relief of
menopausal symptoms such as hot flashes and night sweats. But the study also
showed that taking the hormones on a long-term basis could increase a woman’s
risk of heart attack, cancer and stroke.
After the study was
published, about 65 percent of the women who had been taking HT stopped the
treatment immediately. In the time that’s passed since that study, there have
been some additional findings:
- Estrogen therapy (ET)
alone, which is used by women who have had a hysterectomy, also increases the
risk of blood clot and stroke. It too should not be used on a long-term basis
for prevention of disease. And while ET does pose fewer risks than combined
HT, women who still have a uterus should not take estrogen because it
increases their risk of uterine cancer.
- For 90 percent of women,
hot flashes last for about four years. But women whose hot flashes last longer
should not rule out continuing on HT, even though it’s recommended that
patients stay on the treatment for as short a period of time as possible. This
is a decision women should discuss with their doctors.
- Women who take HT or ET
should take the smallest possible dose—just enough to relieve symptoms. And
they should review their treatment each year with their doctors to determine
whether they should continue or stop the therapy.
Additionally, the report
issued the following information:
- Anti-depressants in the SSRI category are often effective in stopping or decreasing hot flashes. (It’s
believed that some serotonin receptors in the brain play a role in the
development of hot flashes.)
- To date, there’s no
conclusive evidence that alternative herbal therapies are effective in the
treatment of hot flashes. Herbs such as wild yam, black cohosh and
phytoestrogen supplements produced “no significant effect” on symptoms.
One of the main messages of
ACOG’s report is that there’s no single way for women and their doctors to
incorporate HT into their treatment of menopausal symptoms. While the initial
findings about HT scared many women into stopping these therapies completely,
continued research has shown that used with caution and an understanding of the
risks and benefits, hormone therapies are extremely appropriate for the relief
of menopausal symptoms in many women.
Special Supplement to Obstetrics and Gynecology,