Study backs hormones for menopausal women
A new study may reassure some women considering short-term use of hormones to relieve hot flashes and other menopause symptoms. Starting low-dose treatment early in menopause made women feel better and did not seem to raise heart risks during the four-year study.
However, the research didn’t address the risk of breast cancer, perhaps the biggest fear women have about hormones since a landmark study a decade ago. The new one was too small and too short for that.
Still, it is the first fresh research in many years on the sometimes confusing effects of hormones on women’s health. The advice remains the same: Use hormones only for severe symptoms — not to prevent bone loss or aging-related problems — at the lowest dose for the shortest time possible.
“The benefits outweigh the risks when hormone therapy is used for symptom management with relatively short-term treatment,” said Dr. JoAnn Manson, preventive medicine chief at Brigham and Women’s Hospital in Boston and study leader.
For decades, doctors believed hormone pills helped prevent heart problems and were good for bones and minds. That changed in 2002, when a big federal study was stopped because women taking estrogen-progestin pills had higher rates of cardiovascular disease and cancer.
Critics pounced on the study’s limitations. Participants were well past menopause — 63 on average — and most were not seeking symptom relief. Many were overweight and smokers, and at higher risk of heart disease to start with. Only one type of pill in one dose was tested.
Women who could take estrogen alone — those who had had hysterectomies — did not have the risks that women on the combination hormone pills did. In fact, they had lower rates of breast cancer.
These factors led many experts to think some hormones might help certain women, and that the type and dose might matter. The new study tested that.
The main goal was seeing whether hormones made a difference in hardening of the arteries, a precursor to heart disease as seen on imaging tests. Other health measures also were tracked. After four years, doctors found:
1. Both types of estrogen reduced hot flashes and improved bone density, mood and sexual health.
2. Estrogen pills raised good cholesterol and lowered the bad form, but also caused triglycerides (another type of fat in the bloodstream) to rise.
3. Estrogen patches did not affect cholesterol but improved bloodsugar levels and insulin sensitivity, possibly making them a better choice for overweight women at risk of diabetes.
Women need to realize the new study is much less definitive than the big federal one that found more lung and breast cancer deaths among women on estrogen-progestin pills, said one researcher involved in the earlier work, Dr. Rowan Chlebowski.