Public and professional opinion about how hormone therapy can ease the effects of menopause has swung dramatically in recent years – confusing millions of women who could benefit from it.
“Back in the 1990s, doctors thought that hormone therapy was really good for all women,” says Heather Havener, MD, OB-GYN and a Menopause Society Certified Practitioner on the medical staff at Methodist Mansfield Medical Center. “They thought it would decrease the risk of heart disease, decrease the risk of dementia — just basically improve quality of life.”
Then came a Women’s Health Initiative study in 2002 that suggested giving post-menopausal women a boost of estrogen and progestin actually raised the risks of heart attacks, strokes, blood clots, and breast cancer.
“There were women flushing their hormone therapy medications down the toilet in the early 2000s,” Dr. Havener says. “They thought these doctors have been trying to kill us.”
In the years since that ground-shaking but ultimately flawed study, researchers have reanalyzed the data and concluded that it overstated the danger and that the benefits outweigh the risks for many women in their 40s and 50s.
“We’ve learned a lot in the years since that study suggested that hormone therapy increases the risk of heart attack, stroke, dementia, and breast cancer,” Dr. Havener says. “New research shows it’s more complicated than that.”
HEART AND BRAIN HEALTH
When results from that 2002 study were broken down by age, researchers found that women younger than 60 — or within 10 years of menopause — did not face higher risks of heart attack or dementia.
“The younger you are, the more likely it is that it could potentially decrease those risks,” Dr. Havener says. “I don’t promote it solely for cardio protection or brain protection because I don’t feel that we have the data to prove it helps. But we do have enough data to say it’s not going to increase those risks, and it can definitely improve your quality of life.”
The mistake that 2002 study made was lumping together older women with younger patients who were in perimenopause or just beginning menopause, says Tiffany Woodus, MD, OB-GYN on the medical staff at Methodist Charlton Medical Center.
“We made a lot of mistakes,” Dr. Woodus says. “The study took older women whose risk profile was already high for stroke, heart attack, and blood clots, gave them medicines that bumped them up even higher, and had bad outcomes. Hormones got a bad rep.”
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UNDERSTANDING CANCER RISKS
The picture is a bit more complicated for how hormone therapy affects the risk of cancer because the hormone progesterone is a mixed bag: It protects against uterine cancer but, like estrogen, it can stimulate growth in breast cancer.
“Most breast cancers are hormone receptor positive, meaning hormones increase the growth of the cancer,” Dr. Havener says. “Most studies show that using both estrogen and progesterone does slightly increase the risk of breast cancer.”
While the increased risk is statistically significant, that increase amounts to 10 additional cases per 10,000 women per year, Dr. Havener notes, so it’s “not a big number.”
“Regarding breast cancer,” she adds, “taking estrogen alone does not seem to increase the risk. So if you’ve had a hysterectomy, you really don’t even have to think about the risk of uterine cancer.”
There’s also a misconception that hormone therapy causes cancer, says Christine McCrae, PA-C, MSCP, physician assistant at Methodist Family Health – Murphy and a Menopause Society Certified Practitioner.
“Hormone therapy does not cause breast cancer,” she says. “If someone’s already predisposed, hormones can feed it. That’s why regular mammograms are so important.”
If a woman is diagnosed with breast cancer, she will need to stop therapy because tumors and hormones are a dangerous combination. Similarly, if she has a history of breast cancer, personally or in the family, doctors may shy away from offering hormone therapy.
Hormone therapy drugs contain a much lower dose of estrogen than birth control pills.
TALK TO YOUR DOCTOR
The bottom line is that the decision to start hormone therapy should involve a frank and thorough discussion with a healthcare provider who understands the risks and can put them in context with your situation and unique medical history.
“Think about the things that are bothering you that you think are menopause-related,” Dr. Havener says. “What symptoms are you having? How much are they affecting your quality of life? Then look at the possible risk and decide if it’s the right choice for you.”
Dr. Woodus reiterated that “we are so much smarter now” than even 20 years ago when that study turned hormone therapy into a boogeyman for so many women.
“We now know if you’re transitioning, if you’re right in the thick of things, it’s the safest time period to use those medicines,” she says. “So please don’t hesitate to have a conversation with your physician. We have safe and effective medicines that will help give you the quality of life you deserve. You do not have to suffer.”
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