More than 20 years ago, menopause hormone therapy (MHT) was the most commonly prescribed relief plan for menopausal women in the United States. But that changed seemingly overnight when the shocking results of a major study, the Women’s Health Initiative (WHI), challenged its safety and efficacy.
Now, in a newly released long-term follow-up of the WHI, researchers have found benefits of hormone therapy for the treatment of menopause symptoms outweigh the risks.
The findings concluded that for most menopausal women under 60, it is safe to take hormone treatments for several years with adverse side effects being low.
“The results of this study are not surprising to many who have known that hormones, namely estrogen, is very beneficial for women as far as symptom relief and decrease in lifetime quality,” said Jessica Shepherd, MD, and Flow Space Advisory Council member.
The landmark study that impacted women’s health
In the late 1990’s and early 2000’s, women experiencing severe menopause symptoms, enough to interrupt their daily life, were often prescribed MHT. Symptoms like: hot flashes, vaginal dryness, night sweats, pain during intercourse, mood swings or mental health issues, brain fog or confusion, low bone density, or insomnia.
To better understand how this therapy worked, the WHI analyzed data from more than 161,000 women taking hormone replacement therapy. But the study was stopped after researchers found women taking the therapy had an increased risk of cardiovascular disease, stroke, pulmonary embolism, and breast cancer, and women taking a combination of estrogen and progestin had higher risks of breast cancer and stroke.
Upon these findings, prescriptions plummeted, women stopped taking the therapy, and many doctors became hesitant to recommend MHT.
Many years later, the design of the study came under intense scrutiny as it found the large number of older women in the study skewed the results. The increased risks were predominantly in older women who were no longer in menopause, and would not be as likely to be taking MHT, while the younger women in the study had much more positive outcomes from the therapy.
The follow-up findings
A recently released long-term follow-up suggests that the drugs are a safe option for treatment of menopause symptoms in women under 60. However, one major finding that was in the original review and is reinstated again is hormones are still not recommended for long-term use to prevent heart attack, dementia, or other chronic conditions.
“I feel the study allows doctors and patients to see the benefit of HRT in a positive way that may have had concern and questions surrounding the risk versus benefit and also outlines who should not take it, and that it can be taken before actual menopause which is crucial to longevity,” said Dr. Shepherd.
Here are some of the significant findings in the follow-up:
- Hormone therapy had the opposite effect on breast cancer risk than the original findings suggested. Menopause hormone therapy did not increase breast cancer risk and, women who used estrogen alone saw a 20 percent reduction in breast cancer risk over the follow-up period.
- Hormone therapy didn’t increase mortality rates in any age group, when compared to women of similar age taking a placebo.
- When researchers halted the study in 2002, they reported a 29 percent increase in heart disease risk among women taking the therapy. Now they say there is no significant difference in cardiovascular risk between hormone users and non-hormone users.
- Bone fracture risk among therapy users was 33 percent lower across all age groups compared to the placebo group.
Why the report doesn’t go far enough
In light of the follow-up, menopause experts are not surprised, but say it’s come a little too late.
“The backtrack does not surprise me,” said Heidi Flagg, MD and Flow Space Advisory Council member. “Nor is it new news. For the sake of women’s health and well being, it is regrettable that it has taken so long to reverse the 2002 findings in the media space.”
But despite the reversal of many recommendations, some experts say the findings contradict themselves and are harmful to women.
Corinne Menn, M.D., OB-GYN and menopause specialist pointed to the study’s conclusion that hormones are still not recommended for dementia, heart attacks, and other chronic conditions.
She said in an Instagram Reel that the WHI is downplaying their own positive findings and misstating and not providing nuance for any of their negative findings.
“Women have woken up and menopause specialists know WHI is not the bottom line,” she said. “The meno-posse of experts is going to push back on this.”
Midi Health Medical Director of Community Education and Outreach, Lauren Streicher, MD and OB-GYN, had similar thoughts. She said in an Instagram Reel that the findings contradict themselves.
“Just when I was getting hopeful that the WHI was finally, finally, in the rear view mirror it rears its ugly head again,” she said. “This article literally states the fact that women who take hormone therapy are less likely to die, then inexplicably comes to the conclusion that wait for it, hormone therapy should only be prescribed in early menopause to help with moderate to severe symptoms. It makes no sense.”
Despite these findings, experts agree that hormone therapy is safe and effective, and when prescribed correctly can be life-saving and provide relief of menopause symptoms.
“The overall message is to know that hormone therapy does not increase risk of breast cancer, said Dr. Shepherd. “It is safe to take and we can also start it in the perimenopausal phase.”