Hormone therapy called best to ease menopause symptoms

WASHINGTON -- Hormone therapy for postmenopausal women comes with clear risks but remains the most effective treatment for hot flashes and night sweats, say recommendations issued yesterday.

Women who try estrogen should use the lowest possible dose for the shortest period of time, the American College of Obstetricians and Gynecologists stressed.

About 10 percent of women will suffer these menopausal symptoms for longer than the average four years -- and if hormone therapy offers them relief, it shouldn't be withdrawn, the new recommendations conclude.

The doctors' group issued the new guide because of continuing confusion stemming from a major 2002 study that found hormones not only didn't keep postmenopausal women generally healthy -- once a top reason for using them -- but could spur heart attacks, strokes, and other illnesses.

Millions have since quit hormone therapy. Those who get no menopause relief from alternative treatments often have a hard time persuading a doctor to provide estrogen, said Dr. Nanette Santoro of the Albert Einstein College of Medicine, who coauthored the new guide.

"There was such a fear of hormones that they began to be viewed as poison," Santoro said. "Yet for some women, nothing works better."

So the group examined the 2002 research and a string of additional hormone studies performed since. Among the findings:

Antidepressants known as SSRIs, such as Prozac, also can relieve hot flashes even in women who aren't depressed, offering a potential alternative before resorting to hormones.

Herbal remedies such as black cohosh, wild yams, or soy don't seem to work. Women with mild symptoms might get a short-term placebo effect, but in strict scientific studies, the herbs perform no better than dummy pills, Santoro said.

Estrogen remains the most effective treatment for hot flashes and night sweats, and taking it either orally, through a skin patch, or vaginally seems to work. It doesn't alleviate everyone's symptoms; a four-week trial may be necessary.

Estrogen alone -- an option only for women who've had a hysterectomy -- increases the risk of strokes, blood clots, and possibly dementia. Combination hormone therapy -- estrogen plus progestin -- raises the risk of heart attacks, strokes, blood clots, and breast cancer.

Some women have additional risk factors for those conditions that hormones could exacerbate, such as high blood pressure or cancer in the family. And while many doctors consider long-term use the biggest problem, the risk of blood clots or clot-caused heart attacks starts rising immediately.

The decision to take hormones requires a case-by-case judgment of how bad the woman's hot flashes are compared with her individual risk of side effects, the guide says. Hormone users should review that decision annually with their doctors -- they may have become more prone to side effects, or the symptoms may have eased enough for them to quit.

That is similar to advice from the Food and Drug Administration and other medical authorities. But the gynecologist group goes a step further to stress that "it is inappropriate" to withhold hormones from appropriate candidates.