For many years, hormone therapy (HT) was the standard treatment for menopause symptoms such as hot flashes. It was also thought to have health benefits. Most notably, experts believed it helped prevent heart disease.
But a landmark study called the Women's Health Initiative showed that HT did not protect women's hearts. In fact, long-term use of hormone therapy (both estrogen-only and combined estrogen-progestin) slightly raised the risk of stroke and blood clots in older women. Combined therapy also raised the risk of heart attack. (The effect of estrogen-only therapy was not clear.) The increased risks were small, but they were enough to cause a dramatic shift in thinking about hormone therapy.
Since that first study, further research showed that combined HT raises the risk of breast cancer in postmenopausal women with a uterus. Women who took estrogen alone had more abnormal mammograms but no increase in breast cancer.
Here is a brief summary of the findings.
Pros of hormone therapy
Cons of hormone therapy
The bottom line: The risks of hormone therapy outweigh the benefits for many women. Experts continue to study estrogen and progestin and their effects on the body. Until more is known, each woman should weigh the pros and cons of HT based on her personal health history.
What are the current recommendations?
Hormone therapy is still the most effective treatment for moderate to severe menopause symptoms. Your doctor might recommend it to:
- Decrease hot flashes, night sweats, vaginal dryness and other menopausal symptoms
- Prevent bone loss if you are not able to use other medications for this purpose
HT should be taken at the lowest dose and for the shortest time possible to relieve symptoms.
HT should not be used to prevent heart disease. Other medications and lifestyle changes offer better ways to prevent this.
The final choice about whether to take hormone therapy is up to you. Your doctor can help you weigh the severity of your menopause symptoms against your disease risks so you can make the best decision for you.
Created on 06/09/1999
Updated on 03/10/2010
- U.S. Food and Drug Administration. Menopause - medicines to help you.
- North American Menopause Society (NAMS). The hormone therapy story. In: Menopause Guidebook: Helping Women Make Informed Healthcare Decisions Around Menopause and Beyond. 6th edition. Cleveland, OH: North American Menopause Society; 2006.
- North American Menopause Society. Estrogen and progestogen use in postmenopausal women: July 2008 position statement of the North American Menopause Society. Menopause. 2008:15(4):584-603.
- Women's Health Initiative Participant Website. Questions and answers about the health risks and benefits of estrogen and progestin 3 years after stopping randomized treatment.
- National Heart Lung and Blood Institute, Women's Health Initiative. Questions and answers about the WHI postmenopausal hormone therapy trials.