What was once a hot topic for women has cooled off. Still, new studies continue to pin down the effects of hormone therapy. Could it be right for you?

Until a few years ago, doctors routinely prescribed hormone replacement therapy (HRT) to women approaching menopause. Besides easing their annoying hot flashes and other uncomfortable symptoms of this change of life, HRT was supposed to help prevent all manner of chronic ills.

HRT was viewed as something of a fountain of youth. If a woman could replenish her declining levels of estrogen as she aged, the theory went, maybe she could stave off a heart attack, cancer, dementia, and more. She could stay happier and healthier for life.

All that changed in 2002. A major study known as the Women’s Health Initiative concluded that HRT significantly increases risks for serious health problems such as breast cancer, blood clots in the lungs and legs, heart attacks, and strokes.

In a flash, HRT went from a potential cure-all to a near taboo—a choice limited to women with serious symptoms who felt certain the benefits would outweigh the risks.

So, what has changed since 2002? What more should a woman know?

New Studies
Lots of new research has emerged to fuel the HRT debate. For example:

• Two recent studies suggest that the decline in the incidence of breast cancer in the last few years is linked to women’s decreased use of HRT since 2002. That appears to offer more evidence of the possible link between HRT and breast cancer.
• Other research found that in women with a certain breast cancer gene, use of hormone therapy is associated with a decreased—not increased—risk for breast cancer.
• A major Danish study found no increased risk for heart attack in current HRT users ages 51 to 69, compared to women who had never used HRT. However, women at the younger end of that age range experienced an increasing heart-attack risk the longer they used HRT (unlike the older women).
• Several studies have added to the evidence that any type of menopausal hormone therapy decreases the risk for colorectal cancer, even years after a woman has stopped taking hormones.

A New Look at Old Studies
Researchers have also taken a new look at data from that ground-breaking Women’s Health Initiative study. They’ve clarified that the heart disease and stroke risks from HRT generally aren’t as high as previously thought for women in the younger (50 to 59) age groups—the women most likely to be interested in gaining relief from menopausal symptoms. Health risks appear to rise with age.

The North American Menopause Society (NAMS), among other groups, points out that the “absolute risks” for women are low. This means, for example, that even if HRT raises a woman’s risk of developing breast cancer by 5 to 6 percent with each year of use, the additional risk translates to only about eight additional cases per year of breast cancer for every 10,000 women taking the medication. Women who understand the absolute risks might view HRT more positively as a result.

Women considering HRT need to know that this therapy has consistently been linked to an increased risk for blood clots in postmenopausal women. Birth control pills have a similar effect.

What Experts Recommend
There is general agreement among the U.S. Food and Drug Administration, NAMS, and other groups that women shouldn’t use hormone therapy to prevent heart disease. HRT can help ease moderate to severe hot flashes and symptoms related to vaginal dryness, including itching, burning, or discomfort with intercourse. Women may find it helpful for controlling sleep disturbances, irritability, or reduced quality of life related to menopause. HRT can help limit the bone loss of osteoporosis.

Still, experts recommend that a woman without symptoms of menopause investigate other options for preventing or treating osteoporosis before choosing hormone therapy.

Women with symptoms of menopause are advised to take HRT at the lowest dose and for the shortest amount of time necessary to achieve their treatment goals.

What It All Means
Basically, the guidelines for women haven’t changed much since 2002. However, many younger women in particular may now feel more confident that their risks from HRT are lower than once thought.

Natural menopause, the time of a woman’s last menstrual period, usually takes place between ages 45 and 54. Women who have both their ovaries surgically removed go through menopause immediately.

Symptoms may last several months, or several years—and HRT is still considered the most effective FDA-approved medicine for easing troubling symptoms. So it can be worthwhile to ask your doctor about your personal risks and benefits.

Symptom Relief, Step by Step
Any drug carries a risk for side effects and should be taken with your doctor’s advice. Before choosing hormone replacement therapy:

• Read more about it. You can find information at the website of the North American Menopause Society, www.menopause.org.
• Ask your doctor about your personal risks and potential benefits from taking HRT. A decision should be based on a medical exam, your family health history, your symptoms, and other considerations.
• Weigh the risks with the benefits. For example, if you’re relatively young and have pronounced symptoms of menopause as well as the bone loss of osteoporosis, the added risk for heart disease might be worth the potential benefits from taking HRT.
• Think twice. If your life is not overly disrupted by menopause symptoms, the best approach in some cases might be the “all-natural” one: waiting for your symptoms to subside on their own.
• Consider non-HRT alternatives for treating the symptoms of menopause or for preventing chronic diseases linked to aging. For example, ask your doctor about:
  • Healthy lifestyle changes such as quitting smoking, eating a healthier diet, being physically active, or controlling your weight
  • Medications to protect bone density or prevent or control heart disease
  • Self-care measures that can ease the discomfort of hot flashes. Among them: dressing in layers, managing stress, and avoiding spicy foods and caffeine.
  • Other options for relieving hot flashes. Certain antidepressant medications work fairly well for this purpose. Some women rely on soybeans or soy-based foods or supplements, which contain estrogen-like compounds. However, the safety and benefits of taking soy in concentrated amounts are not yet proven.
  • Products for relieving severe vaginal dryness

By Polly Turner, a feature writer for Vitality.

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