Questions persist regarding HT use

In the middle of the night, my husband rolls over and snuggles against me, his heat-generating body my own personal heating pad. Slowly I rise to consciousness, and more often than he’d like, I throw off the covers and gently (OK, sometimes it’s not so gentle) push him away as the devilish hot flash overtakes me.

I’m 56 years old, and being average in so many ways, I went through menopause at age 51. I took hormones for a few years, mostly because heart disease is rampant in my family. But with the publication of the results of the Women’s Health Initiative, quashing forever our belief that hormone replacement therapy, or HT, helps prevent heart disease, I quit. I’m lucky. My menopausal symptoms were mild, and they are decreasing as the years go by.

But not every woman is as lucky as I was, and their symptoms can be devastating: multiple waves of hot flashes every day, wild mood swings, night sweats and radically disturbed sleep patterns. The WHI was a study that gave us information we needed, based on the gold standard of studies – it was prospective (forward looking), randomized (some get the medications and some don’t, and the selection is a toss-up), double-blind (no one, including the doctor, knew who was taking what, although one could argue that a woman on HT knows she’s on HT), and the number of participants was huge (161,809 women), so the results were statistically valid.

It’s important, first off, to know what the study was about. Researchers were looking at how much HT helped prevent heart disease, since previous observational studies concluded that it did, and they also wanted to know to what degree the potential risks of HT, such as breast cancer and blood clots, canceled out the benefits. The study also explored HT’s effects on colon cancer, osteoporosis and dementia. The average age of women in the study was 63, well beyond the immediate menopausal transition years, so this was NOT a study on HT as treatment for menopausal symptoms.

The study told us that no, HT did not prevent heart disease. Eight more women per year (out of 10,000) got breast cancer than those taking placebo drugs. But since the main arm of the study was halted after five years, most researchers feel that HT didn’t cause the cancer, but just acted like fertilizer on tiny cancers that already were there.

Seven more women per year had a heart attack, eight more women had a stroke, and 18 more women had blood clots form in their legs or lungs. But remember, the average age of women in the study was 63.

There were benefits as well. There were six fewer cases of colon cancer per 10,000 women per year. HT also reduced the number of spine and hip fractures.

The data from this study do not tell us the health effects of using HT short term at the time of the menopausal transition, when women are at a lower risk for breast cancer, heart disease, and stroke. It may even be that hormones started at this time are effective at preventing heart disease. We just don’t know. As we often say, more studies are needed.

So what does this mean for the woman who is less than gently shoving her bed partner onto the floor? The fact is, nothing works as well as estrogen for the treatment of menopausal symptoms. And a much lower dose than we had been using, lower yet than what was used in the WHI, works great.

As always, the decision on whether to take hormones is an individual one based on your own risk factors and your own needs. This is where a good discussion with your health-care provider, one who understands the risks – and benefits – of HT, is critical. It is not a failure if you need hormones to help you get through menopause.

Next week, I’ll talk about alternatives to HT.