Hormone Replacement Therapy, 10 Years Later

The use of hormone replacement therapy to treat symptoms of menopause has been hugely controversial. Once touted as a godsend for women with menopause-related hot flashes, night sweats and vaginal dryness, use of the therapy has dramatically declined since July 2002.

That was when research through the Women's Health Initiative was abruptly halted because an elevated number of cases of breast cancer was detected in the study participants. With that, women began to worry whether the therapy had put them at increased risk, a concern that appeared to be justified when a subsequent decline in breast cancer incidence was linked to widespread cessation of the therapy.

The July issue of a Climacteric, the journal of the International Menopause Society, revisits the topic 10 years later to sort out the therapy's actual effect on women's health. In more than a dozen articles focusing on hormone replacement therapy's relationship to breast cancer, cardiovascular disease, dementia and other conditions, the authors (some of them involved in the original Women's Health Initiative work) conclude that for younger women using the therapy close to the time of menopause, benefits generally outweigh the risks.

A common theme in the articles is that the initial finding that the therapy increases breast cancer risk didn't hold up; the increased risk was actually quite small among younger women, rising among the oldest. The data also revealed a "window of opportunity" during which the therapy's benefits outweigh its risks, one of the articles notes. That window occurs before a woman turns 60 and/or within 10 years of entering menopause.

Here's a summary of some of the journal's findings:

- Women whose breast cancer risk is otherwise low and who suffer from lots of menopausal symptoms may benefit from the therapy.

- It appears that women using hormone replacement therapy have a large reduction 40 percent in colorectal cancer risk.

- The therapy appears to offer substantial bone-health benefits, including a reduction in fracture risk.

- The therapy appears to increase risk of dementia, though it's not clear how that relates to the age at which a woman starts such therapy.

- A small increased risk of stroke is associated with hormone replacement therapy initiated near menopause.

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Hormone Replacement Therapy, 10 Years Later