By the time a woman reaches menopause, her ovaries have all but stopped producing estrogen, a natural change that has both short- and long-term health effects.
Hormone replacement therapy (HRT), which gives menopausal women the estrogen their ovaries are no longer providing, reduces short-term symptoms, such as vaginal dryness and hot flashes, and protects against potentially deadly health risks, such as heart disease, stroke and osteoporosis.
Who benefits most
According to a recent study published in the New England Journal of Medicine, on average, death rates from coronary heart disease among women who use postmenopausal hormones are lower than they are among women who don’t. Women who benefit most from HRT are those with risk factors for heart disease. In this study of 121,700 nurses, a notable 69 percent of the participants had at least one major cardiovascular risk factor. Women who benefit least from HRT are those who have no major risk factors for heart disease. Keep in mind, however, that just 13 percent of the women in the study fell into that category.
Other benefits of HRT are emerging. New research indicates that replacing estrogen after menopause can help delay the onset of symptoms in women with Alzheimer’s disease and may reduce the risk of colon cancer.
HRT worries
Despite the known benefits of hormone replacement therapy, only about 8 percent to 12 percent of women who have gone through menopause use HRT for two years or more. That means many women who would likely benefit from HRT don’t even try it, and among those who do, most don’t stick with the therapy long enough to reap the benefits.
In a survey of 252 members of a menopause support group, those who had tried HRT and quit the therapy did so for two main reasons: They didn’t like the monthly bleeding that occurs with some regimens and they were afraid of breast and uterine cancers.
Checking facts
Monthly bleeding can be eliminated by switching HRT regimens. As for the cancer concerns, let’s take a closer look at the facts.
Estrogen given alone does increase a woman’s risk of uterine cancer. However, women today are given a combination pill that includes another hormone, progestin, which brings risk back down to about the same level as for postmenopausal women not taking HRT.
Although some studies have found an increased incidence of breast cancer among HRT users, other studies have found no increased risk. The Nurses’ Health Study, mentioned above, found increased risk only among women who had been taking HRT for more than 10 years.
When deciding whether to take HRT, experts agree it’s important to keep the risks and potential benefits of HRT in perspective. The average American woman is 10 times more likely to die of heart disease or stroke than breast cancer, and many times more likely to develop osteoporosis than breast cancer.
On the other hand, taking estrogen isn’t the only way to reduce heart-disease risk factors. Diet, exercise and medications that target specific risk factors such as high blood pressure or high cholesterol can all be used to reduce risk of heart disease. Diet, exercise and medication also can be used to help prevent or treat osteoporosis.
Personal choice
With 16 million women poised to be in the menopausal age range—ages 50 to 59—by the year 2000 (and that’s just in the U.S.), experts agree it’s vital for women to make informed decisions about therapy.
What the latest research makes clear is that the decision to take HRT is a highly individual one that must be made by a woman and her doctor. Each woman’s decision will depend greatly on her personal health and family history. For example, a woman with risk factors for heart disease, Alzheimer’s disease or colon cancer might opt for HRT. A woman who is at low risk for heart disease but has a family history of breast cancer might choose to avoid HRT or to use it for fewer than 10 years.
