If you’re like most women—and healthcare providers, too—you may be confused about whether hormone therapy (HT) is an option for you to help deal with the bothersome symptoms of menopause, namely, hot flashes, night sweats, mood swings and vaginal dryness. You may also wonder if HT can protect your heart, as previous claims suggested.

While much has been made of the findings of the Women’s Health Initiative (WHI), which was released in the summer of 2002, shedding new light on the risks of HT, the safety of post-menopausal hormone use has actually been an issue of concern for more than 25 years.

Dealing with constantly changing research findings can be a challenge to healthcare providers, who often attempt to base their advice to you on the latest and best evidence from research. Regarding hormone therapy, this is still especially challenging.

As experts re-analyze the original data from the WHI, new thoughts are emerging regarding the use of HT in particular groups of women such as those in perimenopause, the years around the actual menopause event when menstrual bleeding ceases for at least 12 sustained months.

The use of HT as a preventive therapy for heart disease came crashing to a halt in 2002 when the early results of the WHI showed no heart-protective effects of HT or estrogen therapy (ET), but did show an increased risk for cardiac events during the first year of hormone use.

This was big news—the WHI was ended early. Within a month, more than 215 articles were published in newspapers and magazines, and some 22,000 mentions emerged in the scientific literature about the findings. Talk about headline news! Sales of HT dropped by 66% as women suddenly stopped using it and reported feeling uninformed, afraid and confused about what to do.

Advice within the clinical practice guidelines that healthcare providers use to guide your care shifted from information regarding HT as a preventive therapy to using HT as therapy for menopause symptom relief only. The guidelines issued by the North American Menopause Society still stress that HT should be used for symptom management for the shortest term, at the lowest dose and for no more than 5 years. According to the FDA, HT increases the chance in some women of getting blood clots, heart attacks, strokes, breast cancer and gallbladder disease. If you have a uterus, estrogen increases your chances of getting endometrial cancer (cancer of the uterine lining). Adding progestin lowers this risk.

So, what does this mean for you when you’re discussing the use of HT or ET for the symptoms of menopause with your healthcare provider?

The data from the two WHI trials suggest that if you’re between the ages of 50 to 59, you may have a reduced risk of coronary heart disease (CHD) if you take ET or HT within 10 years from the onset of menopause. The takeaway message for women seems to be that HT may delay heart disease in early menopause but can actually increase the risk or trigger a heart event in older women with existing heart disease.

HT may be an option for you for symptom relief if you’re at or near menopause. But in older women, particularly those 20 or more years from menopause, HT may trigger heart attacks or stroke. Even with this advice, experts are quick to caution that for midlife women near menopause, using HT doesn’t “imply an absence of harm over prolonged periods of hormone use,” according to the re-analysis published in the Journal of the American Medical Association.

Additionally, the re-analysis is also suggesting that ET use in this same age group of women may reduce the build-up of plaque in the arteries that could lead to coronary artery disease, particularly in younger women. According to the authors, the data from this study and the WHI provide some reassurance that at least ET is unlikely to cause a negative heart event in women who have just experienced menopause and who are considering ET to manage bothersome symptoms.

Experts at the FDA recommend that if you’re taking HT or ET, you should monitor your symptoms and check with your healthcare provider at least every 6 months about whether you need to continue using this therapy for symptom management.

What it can do

• Help with the symptoms of menopause when used at the lowest dose and for the shortest time around the time of menopause.
• Help prevent osteoporosis, although there are other prescription choices and lifestyle and dietary actions you can take.

What it can’t do

• Prevent heart attacks or strokes. In fact, it can cause them in older women.
• Prevent or delay the onset of Alzheimer’s disease.
• Prevent premature wrinkling.
• Boost your sex drive.

About the Author: Rosemary Theroux, RNC, PhD, is an assistant professor in the Graduate School of Nursing at the University of Massachusetts in Worcester, MA.