Risks outweigh benefits in hormone replacement therapy.




Journal of the American Medical Association

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Consumer Data: Menopause
Professional Data: Menopause


A natural process that unfolds as the ovaries cease to function, menopause generally starts around age fifty. (Early menopause can be initiated by surgery and other causes.) As ovarian function gradually declines, dramatic shifts occur in four hormones that regulate the menstrual cycle: estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). The term "climacteric" is often applied to these profound changes in hormone levels.

Around the ages of 48-52, many changes begin to occur in a woman's body. Unwanted symptoms of hormone imbalances include headaches, insomnia, mild depression, hot flashes, and heart palpitations among others. Convention therapy to ease these symptoms usually involved hormone replacement. Hormonal replacement generally consists of taking a synthetic form of estrogen along with a progestin. HRT influences many aspects of health: menopausal symptoms, osteoporosis, cardiovascular disease, breast and endometrial cancer, abnormal blood clots, and Alzheimer's disease.

A recent study in the Journal of the American Medical Association stated that regardless of many years spent researching HRT, the balance of risks and benefits remains unclear. This proposed 8.5 year study recruited over 16,000 postmenopausal women between the ages of 50 and 79 years to assess the risks and the benefits of hormone replacement. All women received estrogens and some women received progestin while others received placebo. However after a 5-year follow up, the safety board insisted on terminating this trial due to the adverse effects seen with the hormone treatment. Researchers found that HRT increased the risk of invasive breast cancer by 26%, risk of stroke by 41%, risk of blood clots by 100%, and risk of heart attacks by 29%. Although there was a reduction in colorectal cancer and hip fractures, it was clear that the risks of HRT outweighed the benefits of this therapy. The researchers concluded that, "Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women."1


1. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. JAMA. Jul 2002;288:321-333.