Hormone Therapy and health risks
John W. Martin III, MD, a certified menopause practitioner with the North American Menopause Society, is medical director of The Women’s Center at Banner Good Samaritan Medical Center in Phoenix, Ariz. His office can be reached at (602) 839-4351.
Question: I recently began menopause and have terrible hot flashes and night sweats. I’m considering taking hormones, but see conflicting information about links to breast cancer as well as heart disease, stroke, Alzheimer’s disease and more. What should I do?
Answer: Nearly a decade ago, the Journal of the American Medical Association published findings from the Women’s Health Initiative, one of the largest U.S. studies addressing the most common causes of death, disability and impaired quality of life in postmenopausal women taking estrogen alone or with a progestin. This, along with the even larger Million Women Study out of the UK, left women and health care providers confused and frustrated.
Recent literature and data from the Nurses’ Health Study, California Teachers Study, Kaiser Permanente Study, multiple age-specific follow-ups to the WHI, and various European studies all point to the fact that a woman’s age at the onset of therapy is an important factor regarding the risk of cardiovascular disease and dementia. These findings also indicate that estrogen-only and combination estrogen-progestin therapies pose different risks for breast cancer. Supplying estrogen transdermally or vaginally rather than orally is safer in some at-risk women
Based on such reports, I am confident that hormone therapy does not increase the risk of fatal coronary heart disease and may actually reduce the risk of dementia among younger women (younger than 60 or within 10 years of the onset of menopause) with bothersome menopause symptoms and no preexisting risk.
As with most things, hormone therapy is a delicate balance that must be tailored to the individual needs of each woman. For many, cardiovascular disease poses a greater risk than breast cancer. After all, it is the number one killer of women.
Avoiding oral intake of estrogen to bypass the stomach may lessen the chances of cardiovascular disease as well as thrombosis (vascular blood clots) and possibly thrombotic stroke (non-hemorrhagic stroke). Estrogen alone also may slightly decrease the risk of breast cancer. However, taking it with a progestin, especially after five years of use, may moderately increase the risk. As confusing as this may seem, the ability to help prevent dementia is even less clear.
Overall, evidence suggests there is a critical time window when the benefits of menopausal hormone therapy may outweigh the potential risks. There is much to consider, including symptoms, age, whether a woman still has her uterus; risk of breast cancer, cardiovascular disease, dementia, and more. Work with your gynecologist to evaluate your risks and devise a plan that is safe for you. Hormone therapy should never be considered “one size fits all.”