Benefits of HRT for menopause outweigh risks, says new study

HQ Team

May 3, 2024: Hormonal replacement therapy (HRT) has always been a controversial topic. The last twenty years have seen doctors hesitating to prescribe HRT for menopausal women as a major study, Women’s Health Initiative (WHI) in 2002, showed it to be detrimental to women’s health.

Now, a reanalysis of the WHI and a long-term follow-up has shown that this largescale reluctance for HRT might have been a little overdone. In fact, the use of HRT in younger women or in early postmenopausal women has a beneficial effect on the cardiovascular system, reducing coronary disease and all-cause mortality.

“Women in early menopause with bothersome symptoms should not be afraid to take hormone therapy to treat them, and clinicians should not be afraid to prescribe them,” said JoAnn Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital and the paper’s lead author.

HRT history

HRT was commonly prescribed for menopausal women from the 1960s to 1990s. But, the WHI study created a panic fuelled by media hype about the detrimental effects of hormone replacement.

The WHI study enrolled more than 160,000 postmenopausal women between the ages of 50 and 79. But in 2002, it was abruptly stopped due to data suggesting that women in the menopausal hormone group had an increased risk of cardiovascular disease, stroke, pulmonary embolism, and breast cancer.

This about turn forced doctors to halt this therapy for women suffering from acute pre and post-menopausal symptoms such as hot flashes, insomnia, depression, and such. The fallout was that the last two decades most women going through menopause and bearing the symptoms without any effective medical interventions.

But recent followups and analysis of the study have shown that the design of the study skewed the results. The study included a large number of older women, which resulted in fears of cardiovascular and breast cancer risks. It was seen that younger women in the study fared much better with hormonal interventions.

Now the analysis of the data shows that drugs are a relatively safe option for the short-term treatment of menopause symptoms in women under 60. Though, hormones still aren’t recommended for long-term use to prevent heart attack, dementia or other chronic conditions.

Review and relook

The researchers of the study found that HRT did not increase cardiovascular incidents in women of any age group and no significant difference was found in heart risk between hormone users and non-users.

Stroke risk among young hormone users was relatively low.

Combination HRT such as estrogen-progestin and estrogen alone had opposite effects on breast cancer risk. Women who used estrogen alone had a 20 percent reduction in breast cancer risk.

Combination drug use of progestin and estrogen over a long period increased risk of breast cancer.

Bone fracture risk was reduced across all age groups after hormone therapy.

The review study also said that calcium and vitamin D supplements were unnecessary until and unless a deficiency is detected.

Nowadays, women have access to non-hormonal drugs to ease the menopausal symptoms. Also, low dosage estrogen and progestin can be taken via a patch or gel form.

Doctors should exercise caution while prescribing HRT and consider risk factors such as breast cancer history, age, severity of symptoms, heart /stroke symptoms and issues.