Use of hormone therapy (HT) fell sharply after the Women’s Health Initiative (WHI) trial in 2002 warned that the risks outweigh the benefits—and remains lower today than before the study. A recent study in Menopause, which looked at HT use in the five years before WHI and the 10 years after, found a drop in HT initiation from 8.6 to 2.8 percent and a drop in continuation from 84 to 62 percent between the two periods.
The landmark WHI study (different from the 2017 WHI Observational Study described here) assigned more than 27,000 postmenopausal women, ages 50 to 70, to oral estrogen plus progesterone, estrogen alone, or a placebo for an average of five to seven years. It was stopped short because it found elevated risk of heart attacks, strokes, blood clots, and invasive breast cancer in the women taking hormones.
But because the study was designed to look at the effect of HT on chronic diseases (not for relief of menopause symptoms), it included mostly older women who were years past menopause and had taken the hormones for longer than what is generally recommended today—and some results were misinterpreted to apply to all women. That has led many women, including younger women (in their fifties) not at elevated risk, to forgo this effective menopause treatment.
Current recommendations advise that women who have no contraindications can consider HT for relief of menopause symptoms (notably hot flashes), with the least risk if they begin before age 60 or within 10 years of menopause. Keep in mind, though, that recent findings do not support the use of HT for the prevention of chronic diseases, due to lack of evidence of benefit and lingering uncertainties about the risks, and HT is certainly not recommended for any women as the “fountain of youth” it was once touted to be.
This article first appeared in the UC Berkeley Wellness Letter.