Dr. JoAnn Manson considers the evolution of menopause management and hormone therapy (Brigham & Women’s Hospital)
Here’s how we usually describe the medical pendulum swings on hormone treatments for menopausal women:
A couple-three decades ago, some doctors were touting hormone “replacement” therapy as a fountain of youth that might beat back not just hot flashes but many diseases that come with aging. Then research turned up more and more potential risks, from blood clots to strokes and breast cancer. Perhaps, researchers posited, hormone therapy might be okay in younger menopausal women but not in older? The rule became, “It’s complex; talk to your doctor.”
It’s still complex, but a new paper just out in the Journal of the American Medical Association at long last refines 13 years of intense research by the Women’s Health Initiative into a form that I can easily wrap my mind around. In short: Whether you’re in your fifties or beyond, no woman should be taking hormone therapy long-term, in hopes of preventing diseases of aging. Those benefits don’t outweigh the risks. But younger menopausal women with hard-to-take symptoms like hot flashes and night sweats can still consider taking hormones to alleviate them short-term.
To quote Dr. JoAnn E. Manson, the lead author of the new paper and chief of Preventative Medicine at Brigham and Women’s Hospital:
“This is the most comprehensive evidence base available for clinical decision making and it does suggest that hormone therapy should not be used for long-term chronic disease prevention — but it remains an appropriate option for short-term management of menopausal symptoms in early menopause.”
Got that? I asked whether there might be a medical profile that might rule out hormone therapy even for younger menopausal women.
Yes, Dr. Manson said, “If a woman is at very high risk of cardiovascular disease — if she’s had a prior stroke or blood clots in her legs or lungs, or has multiple risk factors, she may not be an appropriate candidate for even short-term treatment. But most women who do have the very significant symptoms — of hot flashes and night sweats and interrupted sleep in early menopause — could be considered for short-term therapy to manage these symptoms.”
Only about 15 to 20 percent of newly menopausal women have symptoms severe enough to consider hormones, she said.
An additional note: If “short-term” use of hormone therapy for menopause symptoms may be all right, just how long is short-term? That remains controversial, Dr. Manson said, but it can be as long as several years.
It has surely been a long, zig-zagging journey toward what now looks like nicely definitive data on hormone therapy.
“The science has advanced in incremental steps,” Dr. Manson said, and it really required a large-scale randomized trial, such as the Women’s Health Initiative, to understand the balance of benefits and risks. And it’s taken a while; there have been many swings of the pendulum. Hormone therapy was once believed to be a fountain of youth, and then it was believed to be too dangerous for anyone to use, and now we understand that there are women who are appropriate candidates, for at least short-term use, and hormone therapy should not be used for long-term chronic disease prevention.” Continue reading