Hormone Therapy Explained

Hormone therapy is a medical intervention which is especially aimed towards women navigating the transition to menopause. In the last 60 years, it has become the most important therapy in treating menopausal symptoms like hot flashes and vaginal dryness. Moreover, estrogen was found to slow down bone loss in postmenopausal women in the 1980s. This discovery was reason enough for the FDA to approve it for the treatment of osteoporosis.

Around the same time, observational studies suggested that hormone therapy might prevent heart disease among middle aged women. It was observed that half of the women observed in these studies who did use estrogen, suffered no heart attacks while the other half who did not use estrogen suffered from numerous heart attacks. This was caused by the effects of estrogen on levels of ‘good cholesterol’ which seems to be increasing while the ‘bad cholesterol’ seems to be decreasing in postmenopausal women. Other studies indicated that hormone therapy might prevent the onset of Alzheimer’s disease.

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Despite these positive findings and experiences, doubts remained about hormone therapy. Was estrogen really protecting the hearts of menopausal women or did those women simply take better care of themselves? One of the side effects of estrogen is increased risk of uterine cancer. In order to lower this risk, adding progestin to estrogen was necessary. Would progestin cancel out estrogen’s heart protection? What about the increased risk of breast cancer and blood cloths?.

Due to these questions and many other questions, the national Institute of Health decided to start a controlled randomized study of 161,809 women spread across the entire US. The study was designed to compare women using hormone therapy and women who were in the ‘control’ group and only given a placebo.

What were the findings of the WHI? Surprisingly the researchers found that the risks of hormone therapy seemed to outweigh its benefits. The risks included increased risk of breast cancer, heart attacks, strokes, and blood cloths for the group of women using hormone therapy. These results were gathered after the study went on for more than 5 years instead of 8 years. The study was terminated after 5 years due to the increased risks faced by the women undergoing hormone therapy.

What do the findings mean for menopausal women; should they never undergo hormone therapy because the drugs used are too dangerous? It must be realized that all types of medications have side effects. The WHI study was designed to to determine whether hormone therapy was really preventing cardiovascular diseases and osteoporosis. The WHI study was not design to study the usefulness of horomone therapy in the treatment of menopausal symptoms.

Many researchers and physicians still have many questions remaining after the WHI study. The WHI study involved the use of a certain formulation of estrogen and progestin taken together daily. The question remains whether this formulation also apply to the numerous other brands of estrogen and progestin on the market? What actually happens if lower doses of estrogen and progestin are used? What about the risks of estrogen-containing skin patches, vaginal creams and the new vaginal ring? Do they carry the same risks? Equally important are questions about the safety and effectiveness of over-the-counter products, which are not stringently regulated by the U.S. Food and Drug Administration (FDA).

In the end, women entering their menopausal years must determine with their physician whether hormone therapy is beneficial or at least not too risky for individual cases.