Reassuring news on hormone therapy for menopausal symptom relief

Women taking a short course of hormone therapy to relieve menopausal hot flashes, night sweats, and depressed moods can breathe a small sigh of relief: A Brigham and Women’s Hospital trial comparing estrogen pills, patches, and placebos found that taking hormones doesn’t pose more health risks than placebos—at least when used over the short-term within a year of two after menopause begins.

In fact, oral estrogen pills (0.45 milligrams a day of Premarin) improved cholesterol levels, lifted moods, and decreased depression, while the estrogen patch (a 50 microgram continuous dose of Climara) protected against diabetes risk factors like insulin resistance and high triglyceride levels; both types of hormone therapy improved hot flashes and night sweats, and increased both density, while neither raised blood pressure levels.

Women were also given progesterone pills to take along with the patch and pills if they didn’t have hysterectomies to protect against uterine cancer, associated with taking estrogen alone.

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“The findings should be reassuring, but they do not provide support for the use of hormone therapy for the prevention of chronic disease,” said Brigham and Women’s Hospital researcher Dr. JoAnn Manson one of the study’s principal investigators who presented the findings on Wednesday at the North American Menopause Society meeting in Orlando.

Manson also helped lead the giant Women’s Health Initiative, which found that the long-term use of hormones started years after menopause raises the risk of heart attacks, strokes, and breast cancer. And most doctors don’t prescribed hormone therapy for longer than five years for symptom relief because the risks of breast cancer increase with longer duration of use.

The new study, involving 772 women in their early 50s who were randomly assigned to use hormones or placebos for four years, was too small to determine whether hormone use raised the risk of breast cancer, heart attacks, strokes, or blood clots since these health problems occur rarely in younger women. It was funded by the non-profit Phoenix-based Kronos Longevity Research Institute and the National Institutes of Health.

“We would have needed to study 30,000 of newly menopausal women to be able to make conclusive comments abut those risks,” said Manson.

What the study did clarify, however, were the advantages of choosing one hormone delivery method over the other.

The patch’s improvement of diabetes’ markers may give it an edge over estrogen pills, Manson said, for women who are at increased diabetes risk due to a family history, obesity or because they have insulin resistance. The patch was also associated with decreased sexual symptoms related to libido, desire, and arousal, though both the pill and patch helped prevent other sexual side effects associated with menopause like vaginal dryness and painful intercourse.

On the other hand, estrogen pills could provide bigger benefits against depression and mood changes associated with menopause, according to the new study, so women experiencing those symptoms may want to choose the pill over the patch.

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