The Women's Health Initiative (WHI) study has shown that HRT does not protect against heart disease. In fact, in a small number of women who are 10 or more years past menopause, it causes heart disease, including heart attacks.7 In the WHI study, short-term use of HRT was also linked to an increase in the numbers of strokes and blood clots. Using HRT for several years was linked to increased cases of breast cancer and dementia. Overall, most women using HRT in the WHI study had no serious side effects, but they also had no long-term benefits.
Among all women, average hormone therapy risks are very low. Your personal risks may be lower or higher than the average. This depends on your risk factors for breast cancer, ovarian cancer, cardiovascular problems, blood clots, or dementia.
Because of the risks of HRT, many experts recommend that HRT be used for:
Short-term treatment of menopausesymptoms. HRT effectively relieves menopause symptoms for most women. Women whodecide that HRT benefits outweigh their risks are advised to use the lowesteffective dose for as short a time as possible.6 Formost women, menopause symptoms naturally improve within a few years' time,making long-term symptom treatment unnecessary.
Osteoporosis prevention and treatment, in selectcases. Most experts recommend that long-term HRT only be considered for womenwith a high osteoporosis risk. In this case, estrogen's bone-protecting benefitmay outweigh the risks of taking HRT. Women are now encouraged to consider allpossible osteoporosis treatments and to compare their risks andbenefits.
Women who have early, sudden menopause after a hysterectomy with both ovaries removed are usually advised to use estrogen replacement therapy (ERT) to protect against bone loss. The low estrogen levels of menopause cause bone thinning. Compared to women who are not taking hormone therapy, women taking ERT have fewer hip fractures (a sign of estrogen's bone-protecting effect).10
ERT also helps with menopausal symptoms. Known ERT risks come from studies of women older than 50. It may be that the benefits outweigh the risks for younger women who take ERT until the age of natural menopause. This question needs further research.
The Women's Health Initiative (WHI) studied estrogen-only therapy in older women and found that it increases the risks of blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism) and the risk of stroke during the first year of use.10 ERT may increase the risk of dementia in women who are older than 65.11 ERT offered no protection against heart disease. In fact, it was linked to heart disease and ovarian cancer in a small number of women.7, 12
Some studies have found a possible link between ERT and breast cancer. In the WHI study, women using ERT had no increase in breast cancer risk during the study's nearly 7 years of ERT treatment.6
It can be hard to understand all about hormone therapy and its risks. There are so many things to think about before you decide how to manage your menopause symptoms. Talk with your doctor about your situation. Review your medical history with him or her. And talk about what benefits and risks hormone therapy may have for you.
In general, short-term, low-dose HRT or ERT may be advised because it offers a balance between the benefits and risks of hormone therapy. HRT or ERT can relieve certain menopause symptoms. And if it is taken for a short time, you may avoid some of the risks related to long-term hormone therapy. More research is needed to find out the benefits and risks of using lower doses of HRT or ERT for shorter periods of time.
If you choose to use hormone therapy for a period of time, be sure to have regular checkups with your doctor.
Stopping HRT or ERT. Talk to your doctor before you stop hormone therapy. There is no way of knowing in advance whether you will have menopause symptoms when you stop using estrogen. About 70% of women who stop HRT have tolerable symptoms or no symptoms at all. The remaining 30% have symptoms that are less tolerable or more long-lasting.13
For many women, tapering HRT, which means stopping gradually, results in fewer symptoms.
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