Are estrogens safe for treating the symptoms of menopause?

Probably, yes.

http://www.clevelandclinicmeded.com/online/journal/supplement/menopause/HodisAltsuppl4_08.pdf

The above link is to a wonderful article that I have summarized below.

In 2002 part of a study called the WHI (Women’s Health Initiative) was published.  It linked hormones to an increase in heart attacks, strokes, breast cancer and leg clots.  It also showed that hormones made bones stronger and decreased osteoporosis.  However the 2002 results applied to women that were, on average, 10 years past menopause and about 60 years old when they started hormones. Many of these numbers did not reach statistical significance, that means they could have occurred by chance alone.  That also means the “proof” that bad effects occurred was not clearly established.  Nonetheless many people were quite worried by the results.

However the study was not fully completed in 2002.  Part of the study continued, the “observational trial”.  Some of these results were published in 2007 but more complete analysis of the data was published in 2008.  Those results showed that women who start hormones within 10 years of menopausal symptoms have no clear increase in heart disease.  The number of strokes are not increased. Importantly no clear increase in breast cancer was found.  (Actually no randomized study has shown in an increase in breast cancer rates from hormone use).  It is worth noting that the incidence of diabetes was reduced by hormone users, but this effect may have only occurred by chance. Also surprising was that the number of leg clots that were seen was not significantly elevated. Once again they found that hip fractures rates were reduced. Fractures were reduced by 33% in hormones users, this is a very impressive number.  No other medication can claim such  good results for bone strength.

Why such different results?  It seems that younger women respond differently to hormones than older women.  Younger women that take hormones for hot flashes seem to have very few problems from hormones.  The study that was published in 2002 looked not only at older women, but at women that were also much heavier.  So it could be that weight gain in menopause increases a women’s risk for breast cancer.   But it looks like it is fairly safe to say that estrogens do not clearly cause breast cancer in young women suffering from the symptoms of menopause. 

It also looks like women that start estrogen at the time of menopause and continue hormones for at least 5 years may actually decrease their risk for heart disease by at least 25 percent.  This is very important because far more women die from heart attacks than from breast cancer.  

There have been many studies that support the health benefits of estrogens for women.  So many have been published that the American Association of Clinical Endocrinologists issued a position statement in 2008 supporting the use of estrogens for menopausal women less that 60 years old.  The benefits of estrogen use for these women exceeds the risks.

Menopause is a real problem for many women. The hot flashes disturb their sleep and consequently cause problems with functioning the next day.  These are typically women with many responsibilities,  chronic sleep deprivation is not a recipe for an effective, happy day.  Hormones continue to have the FDA approval for the treatment of symptomatic menopause.  Scientific studies show that hormones are quite safe for this purpose.  These are prescription drugs with clear benefits and some minor risks.  A proper visit to a physician to be examined and discuss individual health is very important prior to using all prescription drugs.  Science changes rapidly.  Any single study cannot apply to all people.

Are estrogens safe for treating the symptoms of menopause?

Probably, yes.

American Association of Clinical Endocrinologists (AACE) position

statement on hormone replacement therapy (HRT) and cardiovascular

risk. American Association of Clinical Endocrinologists Web site.

www.aace.com/pub/pdf/guidelines/HRTCVRISKposition_

statement.pdf. Accessed March 5, 2008.

Heiss G, Wallace R, Anderson GL, et al, for the WHI investigators.

Health risks and benefits 3 years after stopping randomized treatment

with estrogen and progestin. JAMA 2008; 299:1036–1045

Estrogen and progestogen use in peri- and postmenopausal women:

March 2007 position statement of The North American Menopause

Society. Menopause 2007; 14:168–182.