Major women’s health study supports hormone replacement therapy in early menopause

Editors’ notes

Hormone replacement therapy can safely ease middle-aged women’s symptoms during early menopause, data from a major women’s health study show.

Women younger than 60 can use hormone replacement to treat symptoms like hot flashes and night sweats without significantly increasing their risk of breast cancer or other health problems, according to long-term results from the Women’s Health Initiative (WHI).

“The WHI findings should never be used as a reason to deny hormone therapy to women in early menopause with bothersome menopausal symptoms,” said lead researcher Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.

“Many women are good candidates for treatment and, in shared decision-making with their clinicians, should be able to receive appropriate and personalized health care for their needs,” Manson added in a hospital news release.

The WHI involved more than 160,000 postmenopausal women ages 50 to 79. The study tracked their rates of heart disease, cancer and hip fractures, and also included randomized clinical trials of more than 68,000 women to test potential aging treatments like hormone therapy or calcium and vitamin D supplementation.

Prior to the WHI, studies had reported that older women who took hormone therapy had lower risks of heart disease, stroke, dementia, chronic disease and death, researchers said in background notes.

A WHI clinical trial slammed the brakes on hormone replacement therapy in 2002, however, reporting that women taking combination (estrogen and progestin) hormone therapy had an increased risk for breast cancer, heart disease, stroke and blood clots.

But as women participating in the WHI have been followed over two more decades, a more nuanced picture of hormone therapy’s risks and benefits has emerged.

Findings continue to show that hormone therapy does nothing to decrease women’s risk for health problems related to aging like heart disease or hip fractures, counter to pre-WHI studies.

However, hormone therapy has been shown to not be as risky for middle-aged women nearing menopause, and helpful in dealing with symptoms related to that change in life.

“Women also have more options for treatment now, including estrogen in lower doses and delivered through the skin as a patch or gel, which may further reduce risks,” Manson said. “Non-hormonal treatments are also available.”

This WHI update, which was published May 1 in the Journal of the American Medical Association, also includes fresh information on the value of low-fat diets and calcium and vitamin D supplementation.

Although calcium and vitamin D supplements don’t reduce risk of hip fracture in aging women, researchers noted that these supplements can help fill nutrient gaps among those not eating a balanced diet.

Meanwhile, low-fat diets now are associated with a reduced risk of death from breast cancer, researchers report. Earlier WHI findings had found that low-fat diets did not reduce risk of breast or colorectal cancer.

Researchers recommend that women talk with their doctors about whether a low-fat diet diet or calcium and vitamin D supplements would be good for them.

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