Cathy was beginning to understand more about the benefits and risks of using hormones, but she wondered whether there are still questions about the WHI results and menopausal hormone therapy in general. What else needs to be looked at?
Experts now know more about menopause and have a better understanding of what the WHI results mean. But, they have new questions also.
- The average age of women participating in the trial was 63, more than 10 years older than the average age of menopause, and the WHI was looking at reducing the risk of chronic diseases of growing older like heart disease and osteoporosis. Do the WHI results apply to younger women choosing MHT to relieve symptoms around the time of menopause or to women who have early surgical menopause (surgery to remove both ovaries or the uterus)?
- Other studies show that lower doses of estrogen than were studied in the WHI provide relief from symptoms of menopause for some women and still help women maintain bone density. What are the long-term benefits and risks of lower doses of estrogen?
- In the WHI, women using E alone did not seem to have a greater risk of heart disease than women not using hormones. Does this mean that the risk of heart disease in healthy women in their 50s who can use estrogen alone might not be higher than the risk in women who don’t use estrogen?
- Would using progesterone or a different progestin than the one used in the WHI be less risky to a woman’s heart?
- The combination menopausal hormone therapy used in the WHI makes it somewhat more likely that a woman could develop breast cancer, especially with long-term use. Is using a different type of estrogen, a smaller dose of estrogen or progesterone, or a different progestin (instead of medroxyprogesterone acetate) safer?
- Does using estrogen around the time of menopause change the risk of possible dementia in later life as starting it after age 65 did in the WHI Memory Study (WHIMS)?
The National Institute on Aging and other parts of the National Institutes of Health, along with other medical research centers, continue to explore questions such as these. They hope that in the future these studies will give women additional facts needed to make informed decisions about relieving menopausal symptoms.
What are “natural hormones”?
Cathy’s friend Susan thinks she is not at risk for serious side effects from menopausal hormone therapy because she uses “natural hormones” to treat her hot flashes and night sweats. Cathy asked Dr. Kent about them. He told her that there is very little reliable scientific information from high-quality clinical trials about the safety of “natural” or compounded hormones, how well they control the symptoms of menopause, and whether they are as good or better to use than FDA-approved estrogens, progesterone, and progestins.
The “natural hormones” Susan uses are estrogen and progesterone made from plants such as soy or yams. Some people also call them bioidentical hormones because they are supposed to be chemically the same as the hormones naturally made by a woman’s body. These so-called natural hormones are put together (compounded) by a compounding pharmacist. This pharmacist follows a formula decided on by a doctor familiar with this approach. Compounded hormones are not regulated or approved by the FDA. So, we don’t know much about how safe or effective they are or how the quality varies from batch to batch.
Drug companies also make estrogens and progesterone from plants like soy and yams. Some of these are also chemically identical to the hormones made by your body. These other forms of MHT are available by prescription. Importantly, hormones made by drug companies are regulated and approved by the FDA.
There are also “natural” treatments for the symptoms of menopause that are available over-the-counter, without a prescription. Black cohosh is one that women use, but a couple of clinical trials have shown that it did not relieve hot flashes in postmenopausal women or those approaching menopause. Because of rare reports of serious liver disease, scientists are concerned about the possible effects of black cohosh on the liver. Other “natural” treatments are made from soy or yams. None of these are regulated or approved by the FDA.
What’s right for me?
There is no single answer for all women who are trying to decide whether to use menopausal hormone therapy (MHT). You have to look at your own needs and weigh your own risks.
Here are some questions you can ask yourself and talk to your doctor about:
- Do menopausal symptoms such as hot flashes or vaginal dryness bother me a lot? Like many women, your hot flashes or night sweats will likely go away over time, but vaginal dryness may not. MHT can help with troubling symptoms.
- Am I at risk for developing osteoporosis? Estrogen might protect bone mass while you use it. However, there are other drugs that can protect your bones without MHT’s risks. Talk to your doctor about the risks and benefits of those medicines for you.
- Do I have a history of heart disease or risk factors such as high blood cholesterol? Using estrogen and progestin can increase your risk.
- Do I have a family history of breast cancer? If you have a family history of breast cancer, check with your doctor about your risk.
- I have high levels of triglycerides and a family history of gallbladder disease. Can I use MHT? The safety of any kind of MHT in women with high levels of triglycerides or a family history of gallbladder disease is not known. But some experts think that using a patch will not raise your triglyceride level or increase your chance of gallbladder problems. Using an oral estrogen pill might.
- Do I have liver disease or a history of stroke or blood clots in my veins? MHT, especially taken by mouth, might not be safe for you to use.
In all cases, talk to your doctor about how best to treat or prevent your menopause symptoms or diseases for which you are at risk.
If you are already using menopausal hormone therapy and think you would like to stop, first ask your doctor how to do that. Some doctors suggest tapering off slowly.
Whatever decision you make now about using MHT is not final. You can start or end the treatment at any time, although, as we learned from the WHI, it appears that it is best not to start MHT many years after menopause. If you stop, some of your risks will lessen over time, but so will the benefits. Discuss your decision about menopausal hormone therapy with your doctor at your annual checkup.
MHT is not one size fits all
Cathy realized that talking to her friends about what each is doing to relieve menopause symptoms was helpful, but that her decision needed to be just for her. And she was sure that basing her decision just on what she heard on a TV show might not be the best way to choose. She tried to find sources of information that seemed to be unbiased and didn’t have a product to promote. She felt most comfortable with science-based websites like the National Institutes of Health, the U.S. Food and Drug Administration, or doctors’ professional groups.
Each woman is different, and the decision for each one about menopausal hormone therapy will probably also be different. But, almost every research study helps give women and their doctors more information to answer the question: Is menopausal hormone therapy right for me?
For More Information
Other resources on menopausal hormone therapy include:
National Institutes of Health
Menopausal Hormone Therapy Information
The National Library of Medicine MedlinePlus www.medlineplus.gov website has information on many health subjects, including menopause. Click on Health Topics. Choose any topic you are interested in, such as menopause, menopausal hormone therapy, or osteoporosis, by clicking on the first letter of the topics and scrolling down the list to find it.
American College of Obstetricians and Gynecologists
409 12th Street, SW
P.O. Box 96920
Washington, DC 20090-6920
Food and Drug Administration
10903 New Hampshire Avenue
Silver Spring, MD 20993-0002
North American Menopause Society
P.O. Box 94527
Cleveland, OH 44101
For more information on health and aging, including menopause, contact:
To order free publications (in English and Spanish) or sign up for email alerts, go to www.nia.nih.gov/HealthInformation.
Visit NIHSeniorHealth (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health information for older adults. Special features make it simple to use. For example, you can click on a button to have the text read out loud or to make the type larger.