Finding a balance for menopause treatment

By Julie Deardorff Chicago Tribune

AFTER A DECADE of rancorous debate over the risks and benefits of menopausal hormone therapy, experts from more than a dozen top medical organizations worldwide have finally come to something resembling a consensus. What did they decide, and why are women still baffled?

Menopausal hormone therapy, also called hormone replacement therapy, is a treatment for women in the throes of menopause, the inevitable period of life when estrogen naturally declines. Taking estrogen or a combination of estrogen and another hormone, progestin, the synthetic form of progesterone, can alleviate some of the symptoms of menopause, including hot flashes, night sweats, insomnia and vaginal dryness,

Hormone therapy has been under intense scrutiny since 2002, when a large study called the Women's Health Initiative reported that taking additional hormones specifically the combination of estrogen and progestin increased the risk of blood clots, stroke, breast cancer, heart attacks and gall bladder disease for some women. For a woman with a uterus, estrogen treatment alone raises her chance of getting endometrial cancer. The researchers abruptly halted the study, concluding that risks outweighed benefits. Almost overnight, millions of women abandoned hormone therapy.

Since then, however, we've learned that hormone therapy

What's still up for debate? Whether hormone therapy has a preventive role, Stuenkel said. There's some evidence that estrogen therapy can effectively reduce heart disease, but "it's not universally agreed on," she said. Estrogen has a positive effect on bones and can help with treating osteoporosis, but it's not a first-line treatment, Isaacs added. Swiss researchers recently showed that boosting estrogen might enhance muscle strength in post-menopausal women. Still, last year the U.S. Preventive Services Task Force recommended against using hormonal therapy to prevent chronic conditions. Until more is known, "use hormones if you have symptoms," Stuenkel said. If you don't, make some lifestyle changes to help prevent heart disease and other aging-related issues.

"Move more, try the Mediterranean diet, stop smoking. Eat, drink and be merry with a friend," she suggested.

William Young, president of the Endocrine Society, stressed that for healthy women younger than 60 who are in early menopause, hormone therapy can safely treat hot flashes, mood swings and vaginal dryness.

"Too many women don't know this or are so confused about hormone therapy that they are not receiving any treatment at all," Young said.

Which takes us back to the concerns about increased risk of breast cancer. But the real answer is complicated. Basically, after age 50 a woman has a 3 in 1,000 chance of developing breast cancer. If she uses combined hormone therapy for a year, the same therapy used in the Women's Health Initiative study, her risk will be 4 in 1,000, Stuenkel said.

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Finding a balance for menopause treatment