Hormone therapy: Is it right for you?

Until 2002, hormone therapy was routinely used to treat menopausal symptoms and protect long-term health. Then a large clinical trial unearthed its health risks. What does this mean to you?

Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy (as it’s now called) was also thought to have the long-term benefits of preventing heart disease and osteoporosis.

Attitudes about hormone therapy changed abruptly in 2002, when a large clinical trial found that the treatment actually posed more health risks than benefits for postmenopausal women. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And most women on hormone therapy discontinued its use, often without talking to their doctors.

What are the benefits of hormone therapy?

Women who choose standard hormone therapy during natural (nonsurgical) menopause typically take estrogen and progestin, a man-made version of progesterone. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.

Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:

• Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
• Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.
• Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won’t be completed for several years.

For women who undergo menopause naturally, estrogen is typically prescribed along with progestin, a man-made version of progesterone. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.

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