What Did the Study Show?

By Alice Park

The Women's Health Initiative (WHI), begun in 1991 by the National Institutes of Health, is one of the largest studies of women's health ever undertaken. More than 160,000 post-menopausal women ages 50 to 79 were recruited into a variety of trials designed to find the best ways to prevent heart disease, breast and colorectal cancers, and osteoporosis. Thanks to the study's rigid design, most doctors view the WHI as the definitive word on women's health. Final results were due out--and eagerly awaited--in 2005. But one part of the study, involving more than 16,000 women, was halted last week. These women were taking a combination of estrogen and progestin called hormone-replacement therapy (HRT). Researchers concluded that the risks of HRT clearly outweighed the benefits (see table). Though HRT may still be appropriate as a short-term therapy for menopausal distress, women cannot expect it to protect them in the long term against aging-related diseases. Other parts of the giant WHI study, including a trial that looks at the effects of estrogen alone, continue. --By Alice Park

What Can I Do Instead? Hormone-replacement therapy is not the panacea it once appeared to be. But there are plenty of other ways for women to stay healthy well past menopause and to reduce their risk of heart attacks, osteoporosis and other ailments

HEART DISEASE Contrary to early studies on HRT, the WHI showed that the hormones do not protect against heart disease. In fact, they raise the risk. A low-fat diet and regular exercise several times a week are better bets. Lowering cholesterol is also important; if diet is not enough, drugs like statins can help bring cholesterol levels--and the risk of a heart attack--down.

--Bottom line: Forget HRT. Get to the gym, and watch your diet

OSTEOPOROSIS HRT does keep bones from becoming brittle and reduces the risk of fractures. But there are other ways to keep bones strong that do not carry the same risks. These include calcium supplements, drugs like the bisphosphonates and weight-bearing exercise. A newer class of estrogen-like drugs called SERMs (raloxifene is an example) is also showing promise in reducing fractures without raising the odds of breast cancers.

--Bottom line: Lift weights. Drink milk. Explore other medication options

COLON CANCER Colon-cancer rates in the WHI were lower in women taking HRT, but doctors don't feel that the protection against colon cancer outweighs the risk of breast cancer. Early detection of colon cancer is the best weapon against widespread disease; regular colon checkups are a good idea. Eating fruits and vegetables and exercising could also help.

--Bottom line: Eat more veggies, and stop putting off the colonoscopy

SKIN When estrogen levels plummet after menopause, skin cells lose their elasticity and youthful appearance. Hair can become dryer and thinner. Though HRT can combat these hallmark signs of aging, the hormones do so at a high price. Creams and moisturizers may not be as effective, but they won't pose any serious health risks. And there's an ever expanding array of cosmetic procedures.

--Bottom line: Plastic surgery, anybody? Or how about just aging gracefully?

BREAST CANCER The WHI proved definitively what 30 earlier studies could not: HRT does indeed raise the risk of developing invasive breast cancer. Doctors note, however, that further research is needed to determine whether other types of estrogen used in HRT--the WHI studied only one combination--in different doses and combinations are associated with more or fewer breast-cancer cases.

--Bottom line: If you are concerned about breast cancer, HRT is out. Mammograms and self-exams are, of course, still in

STROKE As blood vessels age, they become less flexible, leading to a buildup in blood pressure that can cause strokes. Estrogen, with its tendency to promote blood clots, can add to this risk. Keeping blood pressure down with medication or relaxation programs such as yoga or meditation is a good way to fend off strokes.

--Bottom line: Get your blood pressure down, breathe deeply, and say no to hormones

ALZHEIMER'S Early studies hint that estrogen may help ward off Alzheimer's disease in older women. Some surveys have shown that women who take HRT are less likely to develop the disease, while others have demonstrated that women suffering from Alzheimer's can improve their short-term memory. More complete trials, including one that is part of the WHI, are under way to see if hormone therapy can help prevent or treat the disease.The WHI's results are expected in 2005.

--Bottom line: It's too early to say whether estrogen is helpful

What About Menopausal Symptoms? HRT works best for flushes, flashes and moodiness, but there are alternatives

HOT FLASHES --What they are When estrogen levels drop suddenly, as they do at menopause, the hypothalamus instructs the body to reset its thermostat. Sweating and flushing are the most common symptoms of this transition stage.

Options Natural remedies containing plant-based estrogen, including black cohosh, soy products and wild yams, may provide some relief.

VAGINAL DRYNESS --What it is When tissues, including those in the vagina, are deprived of estrogen, they lose their suppleness and become dry and irritated. Itching and discomfort may worsen with time.

Options Vaginal creams and flexible rings that are placed in the vagina to release low doses of estrogen can alleviate some discomfort. Vitamin E, taken orally or applied topically as a cream, may also help.

MOOD SWINGS --What they are For reasons that are poorly understood, the drastic drop in estrogen levels can cause irritability and depression. Lack of sleep from night sweats may also contribute to tiredness and changes in personality.

Options Relaxation exercises such as meditation or massage can reduce irritability, while antidepressants may be needed for more severe and enduring mood changes.