Hormone therapy for women after their menopause was once advocated as a way
to prevent both menopausal symptoms and cardiovascular disease—this proved to
be only partially correct. The use of menopausal hormone therapy does support
bone health and relieve hot flashes and other postmenopausal symptoms. Years of
research have revealed that hormone therapy with estrogens and progestins taken
together or estrogen alone creates a complex pattern of potential risks and benefits.
The Women’s Health Initiative (WHI) study found that there were increases in the
risk of cardiovascular disease (blood clots and strokes) with 5 to 7 years of use of
either estrogen plus progestin or estrogen alone.54 Combination (estrogen plus progestin)
hormone therapy also increased the likelihood of breast cancer, but estrogen
alone seemed to have no effect. Instead of the desired reduction in mortality, there
was no significant effect on life expectancy among hormone users compared to
non-users. A longer-term follow-up of the WHI concluded that hormone therapy
decreased overall mortality among the youngest women but after 18 years is not
associated with either increased or decreased mortality rates except that the estrogen-
only group may have had a slight longevity advantage.
Research suggests that estrogen plus progestin therapy reduces the risk of diabetes,
fractures, and colorectal cancer but increases the risk of invasive breast cancer,
coronary heart disease, dementia, stroke, and venous thromboembolism. Estrogen
alone decreases the risk of invasive breast cancer, diabetes, and fractures but
increases the risk for endometrial cancer, stroke, venous thromboembolism, and
gallbladder disease. It would appear that there is cardiovascular benefit from hormone
therapy started within 10 years of the onset of menopause but harm if started
more than 10 years after onset or in women older than age 60. However, estrogen
(with or without progestins) is still, by far, the most effective therapy for menopausal
vasomotor symptoms such as hot flashes and vaginal symptoms.
The 2017 hormone therapy position statement of the North American Menopause
For women aged younger than 60 years or who are within 10 years
of menopause onset and have no contraindications, the benefit-risk
ratio is most favorable for treatment of bothersome vasomotor
symptoms (VMS) and for those at elevated risk for bone loss or
fracture. For women who initiate hormone therapy (HT) more than
10 or 20 years from menopause onset or are aged 60 years or older,
the benefit-risk ratio appears less favorable because of the greater
absolute risks of coronary heart disease, stroke, venous thromboembolism,
and dementia. Longer durations of therapy should be for
documented indications such as persistent VMS or bone loss, with
shared decision making and periodic reevaluation. For bothersome
genitourinary syndrome of menopause (GSM) symptoms not relieved
with over-the-counter therapies and without indications for
use of systemic HT, low-dose vaginal estrogen therapy or other
therapies are recommended.
Discontinuation of hormone therapy is typically recommended after 3 to 5 years or
by the age of 60.
The U.S. Preventive Services Task Force recommends against the use of hormone
replacement therapy (HRT). They concluded that the magnitude of both the benefits
and the harms of hormone therapy in postmenopausal women is small to moderate.
The USPSTF concluded with moderate certainty that combined estrogen and
progestin has no net benefit for the primary prevention of chronic conditions for
most postmenopausal women with an intact uterus and that estrogen alone has no
net benefit for the primary prevention of chronic conditions for most postmenopausal
women who have had a hysterectomy.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.