Clinical Trials Shed Light on Postmenopausal Hormone Therapy

By Sylvia Blair
between us Staff
Posted: March 21, 2003

Two large clinical trials on the use of hormone therapy (estrogen plus a progestogen) by postmenopausal women have provided new knowledge that experts say has altered its benefit-risk ratio for postmenopausal use.

Previously seen as having potential benefit in preventing heart disease or osteoporosis, results of the trials indicate that the treatment may produce a slight but significant increase in the risk of cancer.

The clinical trials -- the Women's Health Initiative (WHI) and the Heart and Estrogen/Progestin Replacement Study (HERS), "have created a medical milestone in the course of women's health," said Margery L.S. Gass, M.D., president of the North American Menopause Society.

The Society has issued its report on the findings from these studies and their applications to everyday practice.

The report found that treatment of menopause symptoms continues to be the main reason for hormone therapy.

More specifically, they recommend that women with a uterus and on estrogen therapy should also use progestogen (any natural or synthetic hormonal substance that produces effects similar to those due to the natural hormone progesterone) Women whose uterus has been surgically removed should not use progestogen.

What about prevention of coronary heart disease? The report says hormones should no longer be used for this purpose. Instead, alternative treatments should be considered.

Hormone therapy has been used in the hope of also preventing osteoporosis, and there are reports of benefits. However, the Society notes there are risks, so physicians should consider alternatives as well.

Overall, the use of hormone therapy should be limited to the shortest time needed to meet treatment goals. Lower than standard doses may be used, the report concluded.

Poll Finds Postmenopausal Hormone Therapy Popular Among Women

Although medical experts are now cautioning against hormone therapy, in a recent poll, women reported positive effects on quality of life.

A national Gallup Organization survey commissioned by the North American Menopause Society (NAMS) found that menopause-related symptoms such as hot flashes and night sweats are associated with poorer quality of life.

According to the poll, hormone therapy had the greatest positive effect on hot flashes followed by mood, night sweats and sleep. Among hormone users, 40 percent said it had the most effect on hot flashes, 27 percent said mood, 15.5 percent night sweats, and 12.8 percent sleep.

"The most significant finding was that hormone therapy allowed women with menopause-related symptoms to have the same quality of life as women without symptoms," said NAMS executive director Wulf H. Utian, M.D., Ph.D.

The random telephone survey polled 600 women aged 50 to 64. Almost 37 percent said they used hormone therapy.

Did You Know?

Life expectancy changed remarkably during the 20th century from about 50 years in 1900 to about 80 years in 2000. This increase in lifespan, however, was not matched by an increase in the longevity of the reproductive system. While puberty develops progressively earlier and menopause later, ovarian function, nevertheless, generally stops by the early fifties.

Women, therefore are faced, for the first time in history, with two or three decades of life without great exposure to reproductive hormones. Most women manage well. In some (perhaps 5 to 10 percent), however, the midlife decline in hormones can produce highly distressing physical and/or psychological side effects.