For menopausal women, hormone therapy remains a choice

The risks and benefits of hormone replacement therapy for postmenopausal women have been debated by the medical community for some time. For years menopausal women often took hormones to ward off symptoms like hot flashes and to try to reduce the risk of bone fractures and heart disease. However, since 2002 when a Women’s Health Initiative (WHI) study found estrogen plus progestin therapy raised a woman’s risk of heart disease and breast cancer, many women have shied away from hormone replacement therapy. However, this response may have been too extreme, according to JoAnn Manson, professor in the Department of Epidemiology at Harvard T.H. Chan School of Public Health, and other medical experts interviewed November 9, 2015 on NPR’s Morning Edition.

A 2013 study published in JAMA found women in their 50s who started taking hormones soon after the onset of menopause may benefit from a reduced heart disease risk, said Manson, also a professor of medicine at Harvard Medical School and Brigham and Women’s Hospital.

“Women who take hormones earlier after the onset of menopause may have favorable effect on the development of plaque, of blood vessel blockage, reduced risk of atherosclerosis, and possibly reduced risk of heart attack,” she said. The benefit was not seen in women aged 60 and up, perhaps because they already have plaque buildup in their arteries, she said.

Women considering hormone therapy also need to know that the increased breast cancer risk noted in the original WHI study has been confirmed in other studies, though the risk is small, Manson said. “For every 1,000 women per year not using hormone therapy about 3 would develop breast cancer,” she said. “And among every 1,000 women per year using hormone therapy about 4 of them would develop breast cancer, so that’s about 1 extra case of breast cancer per 1,000 women per year using hormone therapy.”

Manson urged women wanting more information about hormone therapy to talk with their doctor about their individual risks and potential benefits. Those who decide to use hormones should use the smallest dose for the shortest period of time, she said.

Listen to and read the NPR story: Hormones May Help Younger Women With Menopause Symptoms

Watch a September 9, 2015 Medscape interview with JoAnn Manson: The Latest on Managing Menopausal Symptoms (login required)