Hormone replacement therapy: Safe or not?

By Mary Brophy Marcus HealthDay Reporter

WEDNESDAY, Oct. 24 (HealthDay News) -- Is hormone replacement therapy safe or not?

It has taken a decade of research to arrive at a conclusion that is far from definitive: The evidence suggests it may help in the short term to manage hot flashes and other symptoms of menopause in some younger, healthy women. But, taking it for long periods of time or later in menopause to help prevent certain chronic diseases isn't recommended.

On Monday, the U.S. Preventive Services Task Force once again backed the idea that long-term use later in menopause is unwise when it released recommendations that said the increased health risks outweighed the benefits of using the treatment in that medical scenario.

That was not always the prevailing view in the medical community, however.

For years, it was common for women suffering from hot flashes, night sweats and other life-disrupting symptoms of menopause to go on hormone replacement therapy -- typically a combination of estrogen and progesterone or progestin (a progesterone-like medication). That all changed in 2002, when the practice was halted by many after the landmark Women's Health Initiative trial found that rates for breast cancer and stroke were higher in women on hormone replacement therapy compared to women who weren't taking the treatment.

Although the study of more than 16,000 women reported some benefits, including lower rates of hip fractures and fewer cases of colon cancer, there were increases in heart disease, strokes and pulmonary embolisms (dangerous blood clots in the lungs) in women who took estrogen and progestin compared to women on placebo pills. The study, scheduled to run until 2005, was shut down early as a result.

"After 2002 and the Women's Health Initiative study, people just stopped their hormone therapy. I think the study was an amazing study and gave us really good information, but you have to look at it in the time it was organized and developed, in early 2002, 2003," said Dr. Anne Ford, associate professor of obstetrics and gynecology at Duke University School of Medicine.

Hormone replacement therapy formulations have since changed, and more recent research has teased out some groups of women who might benefit from the treatment, she added.

A Danish study of 1,000 women published earlier this month in BMJ suggested that women who began taking hormone replacement therapy early in menopause and who continued taking it for an average of 10 years cut their risk of having a heart attack, heart failure or dying without raising their risk for breast cancer or blood clots.

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Hormone replacement therapy: Safe or not?