HRT Safe? Cutting Through the Confusion

Dr. Marie Savard gets the straight story on hormone replacement therapy.

ByABC News
June 16, 2008, 1:20 PM

June 16, 2008 — -- For the millions of women going through menopause, I don't thing there is anything more confusing than the research surrounding hormone therapy. As a postmenopausal woman who uses a small dose of hormones, every new study grabs my attention.

The latest headline suggests hormones have been declared safe. Did I miss something? Has there been new research from randomized trials (the best form of research)?

It turns out that a worldwide meeting of menopause experts in Zurich, Switzerland, reviewed all the available research and concluded that for healthy women in the first 10 years after menopause -- ages 50 to 59 -- taking hormones is safe.

There is no question that for a woman with severe hot flashes, sleep disturbance and an annoyingly dry vagina, nothing else works as well as estrogen. But the risks of breast cancer, stroke and blood clots from estrogen are hard to ignore. These risks are small in a newly postmenopausal woman but not absent altogether. So once again, women are asked to balance the benefits of hormones with the risks and make the best decision for them.

A second headline grabber recently was the news that although oral estrogen causes an increased risk of blood clots, the skin patch form called transdermal estrogen apparently does not.

This news comes from research that looks at many observational studies of hormones, and not from a randomized clinical trial. But the findings make sense. Oral estrogen must first pass through the liver to be metabolized. This first pass through the liver leads to an increase in clotting proteins. Transdermal estrogen provides estrogen in a smaller dose directly to the blood circulation and so bypasses the liver.

The final new news on hormones -- a simple cholesterol test could help women decide whether to take hormones or not. Researchers studying results from the large Women's Health Initiative Study (this was the study stopped in 2002 when the small increased heart risk was discovered in women who were on average 63 years old when they first started taking hormones) found that women with unfavorable cholesterol levels were more likely to develop heart problems while taking hormones, while women with favorable cholesterol levels did not seem to have an increased heart risk.