Menopause and Hormone Treatment – The Latest Developments

June 2007

In the seemingly never-ending saga (and confusion) surrounding hormone treatment for menopause symptoms, the most recent developments should provide reassurance to tens of thousands of women who have the most severe symptoms when they hit menopause.

First, a bit of background. One big, ongoing government study has been the foundation for the major developments in this area since 2002. The study is called the Women’s Health Initiative, or WHI, and is funded by the National Institutes of Health. The study began in 1991 and has been tracking thousands of women who take hormones (estrogen and progesterone) and comparing them to women who do not.

In 2002, a portion of the WHI study was halted when the data indicated that women who took hormones had a substantially higher risk of heart attacks, even when other risk factors for heart attack were taken into consideration.

This unexpected result was widely trumpeted in the media and led millions of women to stop taking hormones.

But all the while many researchers and doctors were skeptical of the blanket-nature of these results, since several studies in the 1980s suggested a benefit to the heart from taking hormones, especially among younger women.

Then, in January 2006, another large-scale study (following 121,700 nurses in the U.S. but not focused on hormone use or menopause) yielded a surprising result: women who took hormone pills at or just after the onset of menopause (so, women generally in their early 50s) had about a 30% lower risk of developing heart disease. Women who started taking hormones years (10 or more) after the onset of menopause faced about the same risks of heart disease as women not taking hormones, the nurses study found.

That finding and other study results prompted the WHI research leaders to take another, closer look at their data. The outcome of this re-anlaysis, reported recently: indeed, women who started hormone treatment in the first 10 years or so of menopause appear to be at lower risk (if only slightly at about 11%) of heart disease and heart attack.

In contrast, the new WHI analysis found that women who started taking hormone pills 10 to 19 years after menopause were at higher risk (22%) of heart problems, and women who started taking hormone pills 20 years or more after menopause were at substantially higher risk (77%) of heart problems.

The study also found a similar pattern for stroke risk and for women taking estrogen alone.

Importantly, however, the new WHI analysis and the nurse’s study looked just at heart disease and stroke. The WHI and other studies have also linked hormones to a higher risk of dementia and certain cancers, notably cancer of the lining of the uterus and breast cancer (see discussion below).

Thus, overall, the results of the new analysis do not change our core advice in the report on menopause and hormone treatment on this Web site (www.CRBestBuyDrugs.org). That advice remains:

• Hormone drugs should be taken with special care and caution and only after a woman has thoroughly discussed the benefits and risks with her doctor.
• Hormones should never be taken to lower a woman’s risk of heart disease.
• Hormones should generally only be taken if menopause symptoms are severe or significantly disrupt normal life.
• Hormones have no “anti-aging” benefits – such as reducing wrinkling or making women feel more energetic.
Hormones should be taken at the lowest dose for the shortest time possible for women who do need them.

All that said, the new findings do provide assurance to women who suffer severe menopausal symptoms as they first enter menopause. If this describes you, you need not fear that hormone pills are increasing your short- or long-term risk of heart disease or heart attack.

Over time (five years or so), however, the new studies indicate that women whose menopause symptoms persist may be at higher risk of heart problems, especially if they have other risk factors of heart disease such as high blood pressure, diabetes, and elevated cholesterol.

Indeed, some experts now believe that persistent menopause symptoms may be a “marker” for heart disease. That means such women may, for reasons unknown, be at higher risk of heart attack and stroke (independent of other risk factors) as they get into their late 60s and 70s. Such women should not be taking hormones, all the studies now strongly indicate.

Also, if you start taking hormones, your risk of heart disease should be assessed no matter how old you are.

Notably, in March 2007, the North American Menopause Society updated its guidelines on the use of hormones. The group generally agreed with the analysis we rendered above, but came to one additional conclusion worth noting: that hormones remain an option for women at risk of osteoporosis even if they don’t have severe menopause symptoms. The WHI and other studies have found that hormones lower the risk of hip fractures.

Finally, recent findings continue to underscore the link between hormones and a highr risk of breast cancer. A study published in April 2007 found that breast cancer incidence began to decline abruptly in the U.S. in the later half of 2002, just after women by the millions stopped taking hormones (after the initial 2002 WHI scare).

The researchers estimated that about 16,000 fewer cases of breast cancer are now being diagnosed each year because of the decrease in hormone use, a sharp reversal after 20 years of annual increases in breast cancer incidence.