Hormone replacement therapy may provide relief from the hot flashes, night sweats and other oppressive symptoms of menopause, but when it comes to preventing chronic health problems, a panel of experts for the federal government said HRT isn’t helpful and may be harmful.
The U.S. Preventive Services Task Force today recommended against the use of HRT for the prevention of chronic conditions, such as coronary heart disease, breast cancer and fractures, for postmenopausal women. The panel classified the recommendation as “grade D,” meaning there is “moderate to high certainty” that the risks of HRT outweigh any long-term health benefits that women might gain.
The panel noted that the recommendations don’t apply to women taking HRT to relieve hot flashes, vaginal dryness and other postmenopausal symptoms. Women’s health specialists say increasing evidence indicates that reasonable use of the therapy to fight those symptoms can have big benefits for women’s quality of life.
“For newly menopausal women who have these symptoms and are in generally good health, the benefits of treatment are likely to outweigh the risks,” said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.
The USPSTF’s recommendations are the latest chapter in the often-confusing story of hormone replacement therapy, which was once considered a possible tool for preventing chronic maladies such as coronary heart disease and fractures. But the Women’s Health Initiative, a 10-year study of nearly 70,000 women, found that women who took both estrogen and progestin actually had an increased risk of blood clots, heart attacks and strokes, as well as a higher risk of developing breast cancer. The trial was halted three years early in 2002.
The USPSTF cited evidence gleaned from the Women’s Health Initiative in its latest recommendations, saying that the use of estrogen-only HRT or a combination of estrogen and progestin was linked with an increased risk of stroke, gallbladder disease, urinary incontinence and blood clots.
For women taking estrogen-only HRT, the panel found modest benefits in the way of reducing bone fractures and smaller reductions in the risk of developing or dying from invasive breast cancer. But the panel said those small positives were outweighed by the more major risks of the therapy.
Women’s health experts say the recommendations are a positive and not unexpected step from the USPSTF, since the panel made similar recommendations in 2005. Although HRT can help women battling uncomfortable postmenopausal symptoms, Dr. Ranit Mishori, an associate professor at Georgetown University School of Medicine, said there are lots of healthier, less-risky ways to prevent chronic diseases.
“There are no magic pills or magic bullets. Get off your butt, eat a healthy diet, don’t smoke and lead a healthy lifestyle,” Mishori said. “If it’s post-menopausal symptoms that bother you, talk to your doctor about short-term treatment with HRT.”
Increasingly, evidence shows that timing is everything when it comes to the risks and benefits for women using HRT to fight their postmenopausal symptoms. Studies have shown that younger women who take hormones close to the onset of menopause get more benefits and less risk than older women who start the therapy late into menopause.
Also, researchers have found that despite the initial panic over hormones after the WHI trial was halted, using HRT for three to four years around menopause seems to be a fairly low-risk way to improve women’s quality of life. Currently, women are advised to use HRT for as little time as possible and to stay on it no more than five years.
“It all depends on what you take HRT for, for how long and when you start,” Mishori said.
ABC News’ Dr. Murtaza Akhter contributed to this report.