Hormone Therapy Redeemed

By Alice Park

Aging is never easy, particularly during menopause. But for 30 years women could at least depend on estrogen and progestin supplements, a comforting hormonal hand to hold that would not only ease the uncomfortable symptoms of getting older but also keep skin supple and hair lustrous. Doctors even encouraged women well into their 70s to take the treatments, on the basis of studies showing that they protected against heart disease and cushioned bones against osteoporosis-related fractures.

It seemed almost too easy--and it was. In 2002 the quick pharmaceutical fix was all but snatched away when a large government study found that women taking hormones actually increased their odds of heart disease and that they put themselves at greater risk of breast cancer, stroke and blood clots. Women suffering with serious menopausal symptoms would simply have to balance the dangers and the benefits of the hormone treatments.

Now comes a new analysis of those same data that brings clarity to the entire question and redeems hormone therapy, in a way. In general, say the new findings, the therapy is fine for women in their 50s who use it only to treat the night sweats and hot flashes associated with menopause--or essentially what the supplements were supposed to be used for in the first place. "We now have a more refined understanding of the role that age and timing of menopause have in affecting the benefits of hormone therapy," says Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston and a co-author of the study, known as the Women's Health Initiative. "Timing does matter."

The 2002 conclusions had already provided the researchers at the National Heart, Lung and Blood Institute with hints that the heart-disease risk might apply unevenly, varying by age. And faced with growing concerns from menopausal women who depended on the hormones but were concerned about the danger, the investigators decided to take a second, closer look at the data. This time they teased the results apart more clearly into age groups. When they did, they found that the youngest of the women taking hormones weren't putting their hearts at risk so that there is a window of time, right around menopause, during which the therapy is relatively safe.

"If women start hormone therapy within the first 10 years after onset of menopause to treat hot flashes and night sweats, and remain on the hormones for no more than four to five years," says Dr. Jacques Rossouw, lead author of both studies, "they can take the fear of heart disease out of the question."

The same, unfortunately, doesn't hold true for older women. Estrogen and progestin have a habit of aggravating the hard, artery-clogging plaques that develop naturally with age. On the basis of animal studies and other heart-disease trials in human patients, the authors suspect that hormone therapy encourages the clots that form around these plaques to rupture and cause heart attacks. Nonetheless, the latest study offers a backward sort of good news, suggesting that intense menopausal symptoms may be a kind of early warning system, since women who suffer the most also tend to harbor more risk factors for heart disease, from high blood pressure, high cholesterol and diabetes to excess weight. "If you have moderate to severe hot flashes, then that should be a signal to check your risk factors for heart disease," says Rossouw.

Reassuring--or at least illuminating--as all these findings are, hormone therapy is still a gamble. Even in women taking the treatment who were less than 10 years from the onset of menopause, there was a 77% higher risk of stroke and a 19% higher risk of breast cancer. That's why doctors urge those who take hormones to have their blood pressure checked and get regular mammograms. Aging may indeed never be easy, but once in a while it at least gets a little less confusing.