The widespread popularity of hormone therapy (HT) in the United States is a triumph of marketing over science and advertising over common sense. Drug companies and many health care providers view menopause as a disease to be treated — and hormone therapy is a direct response to that misperception. The National Women’s Health Network (NWHN) works to challenge this false claim that women’s bodies are somehow deficient at menopause and need replacement hormones to stay healthy. Drug companies and many health care providers present menopause as a disease, while it is a completely natural transition.
For decades, we’ve been told that the use of estrogen alone or the use of estrogen/progestin together will protect women from age-related disorders and help women look and feel younger. Despite these claims, there is no valid scientific evidence that estrogen prevents Alzheimer’s disease, incontinence or wrinkles, or improves memory, mood, and energy. Recent large randomized trials have proven that an estrogen/progestin combination taken every day causes heart attack, blood clots, stroke, breast cancer and makes women feel worse. A similar study of estrogen taken alone found comparable results.1,2,3
There is evidence that taking hormones at menopause reduces the symptoms of the menopausal transition and delays bone loss. Estrogen and progestin in combination reduce the risk of fractures and colon cancer, and estrogen alone also reduces the risk of fractures. But in the largest and most rigorous study, the risks of the combined hormones outweighed the benefits for healthy women.
Thanks to the NWHN’s advocacy efforts and the results of the Women’s Health Initiative — the largest long-term study of older women’s health ever conducted — women now know the truth: taking menopause hormone therapy increases the risk of breast cancer significantly. As a result of these findings, menopause hormone therapy use and breast cancer rates have both dramatically declined. In 2013, there were about 8 percent fewer cases of breast cancer than in 1990, which translates to 18,000 fewer women being diagnosed with the disease each year.
There is evidence that taking hormones at menopause can reduce symptoms like hot flashes and delay bone loss. Taking a combination of estrogen and progestin reduces the risk of bone fractures and colon cancer; taking estrogen alone can also reduce the risk of fractures. But findings from the largest and most rigorous study conducted to date clearly show that, for healthy women, the risks of combined hormones, including increased risk of breast cancer and serious cardiac events, outweigh these benefits.
Hormones Have Not Been Shown To:
1. prevent wrinkles or other natural signs of aging
2. cure urinary incontinence
3. help moodiness or depression
4. improve sexual desire or responsiveness
5. improve memory
6. help sleep or increase energy in women who do not have hot flashes
7. prevent Alzheimer’s disease
Should I or Shouldn’t I?
There is no clear answer – while alleviating hot flashes, vaginal dryness, and preventing fractures are all proven benefits of HT, the decision must be individualized. The decision should take into account an individual’s medical history, preferences, and concerns. While some women may be interested in using HT in order to alleviate uncomfortable experiences associated with menopause, there are no scientific studies that support the routine use of hormones in healthy menopausal and perimenopausal women.
Currently, scientific evidence supports the use of HT only in the following cases:
- for women who have had both ovaries surgically removed at an early age
- for short-term use by women with severe hot flashes, night sweats, or vaginal dryness
- as one option for maintaining bone density and reducing the risk of fractures in women at high risk for osteoporosis
We recommend that women who experience troublesome hot flashes or vaginal dryness try non-hormonal therapies as the first line of treatment. If a woman chooses hormones, we suggest she take the lowest dose that alleviates her symptoms for as short a time as possible.
We believe that should have medically accurate information about the risks and benefits of both short- and long-term use of HT. Women also benefit from information on using non-hormonal options (including biofeedback, diet, and yoga) for physical experiences associated with menopause. The NWHN fully supports and advocates for research in these areas.
Finally, consumers should be skeptical of products that claim to extend life, reverse aging, restore youth, or prevent disease without any adverse effects. In too many cases, these products not only don’t do what proponents claim but also have dangerous health effects.
The Bottom Line
To us, the bottom line is clear. Some health care providers, influenced by drug company promotions, are pressuring women to take hormones as soon as their regular menstrual cycles start to change. Much information in the popular media also echoes the interests of drug companies and encourages women to think of menopause as a disease, or a state of estrogen deficiency state, and to begin taking hormones as soon as possible.
Both groups make it sound as though the cessation of normal menstrual cycles does lasting harm to the body within days or weeks of its onset. The truth is that it doesn’t. Most women have months or years to make decisions about whether or not hormones make sense for them and to reevaluate their decisions as their situations change or as new scientific information becomes available. We urge you to take all the time you need to make an informed decision about starting or continuing hormones.
The National Women’s Health Network is committed to ensuring that women have access to accurate, balanced information about hot flashes. If you have a question you would like to ask NWHN, submit it on our weekly Q & A column “Since You Asked.” Stay informed, connect with us on Facebook and Twitter.
1. Writing group for the Women’s Health Initiative investigators, “Risks and benefits of estrogen plus progestin in healthy postmenopausal women,” JAMA, 2002; 288: 321-333.
2. Hlatky M, Boothroyd D, Vittinghoff E et al, “Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy,” JAMA, 2002; 287: 591-597.
3. The Women’s Health Initiative Steering Committee, “Effects of conjugated equine estrogen in postmenopausal women with hysterectomy,” JAMA, 2004; 291: 1701-1712.