The last word on hormone therapy?
Hot flashes? Trouble sleeping? Hormone replacement therapy may be the best short-term option.
October 1st, 2013
06:01 PM ET

The last word on hormone therapy?

When Janice hit menopause, she had terrible night sweats and hot flashes, but she was scared to undergo hormone replacement therapy.

Janice (who asked that her full name not be used for privacy reasons) had heard this treatment might be dangerous to her heart, and worried about risking her health.

It's a concern many American women have shared over the past decade since the benefits of hormone replacement therapy have been called into question. A large study called the Women's Health Initiative (WHI) was instrumental in casting doubt on these hormones.

Tuesday, scientists from the WHI released what they say is the definitive study on the safety of hormone replacement therapy (HRT).  The bottom line: It's OK for most healthy women who have just entered menopause to take hormones for a short period of time, but the researchers do not recommend it for long-term use. The results are published in this week's Journal of the American Medical Association.


Hormone replacement therapy is used to replace estrogen and other female hormones that are no longer produced after menopause. For decades, doctors thought HRT was good for women's hearts and prescribed it, in part, to prevent heart disease.  About 40% of menopausal women used these hormones.

In the 1990s, more than 27,000 women were enrolled in a clinical trial through the WHI. Scientists wanted to find out if HRT really prevented heart disease and other chronic diseases.  But in 2002, a major part of the trial using two kinds of hormones (estrogen plus progestin) was suspended.  Researchers found some of the participants had serious health problems, including an increased risk of coronary heart disease, breast cancer and stroke. Two years later, the remainder of the clinical trial, involving women who had hysterectomies and were on only one hormone (estrogen), was also shut down due to health concerns.

When the WHI study was suspended, it received a lot of attention, both in the medical world and in the media. Many doctors stopped prescribing oral HRT.  Today only about 10% to 15% of menopausal women still take them, experts say.

The study

For this study, scientists looked back at 13 years of research on the WHI participants. The main message is: Most menopausal women should not use long-term hormone therapy for the purpose of preventing heart disease or other chronic diseases, says Dr. JoAnn Manson, one of the principal investigators of the WHI trial and Chief of Preventive Medicine at Brigham and Women's Hospital in Boston, Massachusetts.

The WHI research found older women taking HRT are at a higher risk of blood clots, stroke and, in some cases, heart attacks.

But for most healthy women who are beginning menopause and suffering severe symptoms such as hot flashes and trouble sleeping, HRT can be a good option.

"It's very likely that the quality of life benefits will outweigh the relatively small risk of having an adverse event," Munson says.

However, Munson adds, women who have a history of heart disease or breast cancer may want to avoid HRT.

Some observers hope this study will put to rest the debate over HRT.  Over the years, some doctors have been critical of the way information from the WHI HRT trials has been interpreted.

"There are some risks and there are some benefits, but the risks in the grand scheme of things are not nearly as great as they have been portrayed," said Dr. Holly Thacker, director of the Cleveland Clinic Center for Specialized Women's Health in Cleveland, Ohio.

"Many of my patients still fear them, out of proportion to the data. This result helps put them into perspective once again and ought to be reassuring to women with average risk," says Dr. Nanette Santoro, chair of the Department of Obstetrics and Gynecology at the University of Colorado in Aurora, Colorado.

About 15% to 20% of women in early menopause have moderate to severe symptoms and might benefit from taking HRT, according to Manson. Health care providers now often prescribe lower doses of oral HRT or potentially safer options such as the hormone patch, gels or vaginal creams.

For Janice, talking to her doctor put her mind at ease.

"My doctor explained the pros and cons of hormone therapy, assuring me that for me it was a good option," says Janice. "My night sweats are pretty much gone."

For more information:

The Hormone Health Network's menopause map

North American Menopause Society

'pause, a magazine produced by the American College of Obstetricians and Gynecologists

soundoff (32 Responses)
  1. liz

    where is my post?

    October 1, 2013 at 19:02 | Report abuse | Reply
  2. liz

    that's 2!!!! i would like to know why my other posts are not showing up?

    October 1, 2013 at 19:06 | Report abuse | Reply
  3. liz

    ok... let's try this: HRT that involves pregnant mare's urine is cruelty to animals. HIDEOUS cruelty to animals. that's a FACT.

    October 1, 2013 at 19:09 | Report abuse | Reply
  4. Eveline Rudin Metz

    So glad we've come to an expert agreement. I am 72, strong, healthy, can fold my legs like a pair of scissors despite having had two knee replacements. I do HRT since 25 years, plus I take a tiny cardio aspirine every day, and I enjoy life to the fullest.

    October 1, 2013 at 19:18 | Report abuse | Reply
    • Diana

      I've been on low-dose HRT for 20 years now, and feel great. In addition, I've been able to build bone density with relatively heavy weight lifting ... this would not have been possible in the absense of estrogen. When the original study first came out my MD pointed out the very bad methodology used (introducing HRT to much older women who were long-since post menopausal) and I am glad I listened to him. People should be reading the original research (NOT just an abstract) and looking at it critically and forming their own opinions.

      October 4, 2013 at 13:30 | Report abuse |
  5. Linda

    Why didn't they look at bio-identical hormones? Why did they only look at artificial hormones? This study doesn't tell us what we want to know. It just tells us to continue to buy drugs from the pharmaceutical industry, who would also like to sell us drugs to treat breast cancer, cardiovascular disease, and more health problems as a result of their artificial hormones. That's not the only problem with this study by a long shot, but detailing all of its flaws would take a dissertation and there isn't room in these comment boxes for that kind of analysis.

    October 2, 2013 at 07:04 | Report abuse | Reply
  6. Laurie

    This is an article about women in menopause. Why does the picture show a woman who can't be over 30 sitting in front of a fan? It would be nice if the photos chosen actually reflected the content of the article they are attached to. There is no shame in being an older adult who looks like an older adult!

    October 2, 2013 at 09:05 | Report abuse | Reply
    • Sherri

      Good eyes Laurie. She does look kind of young.Although I started having hot flashes at 39 so she could just be in good shape. We'll never know.

      October 2, 2013 at 17:59 | Report abuse |
    • Dug

      Lauie, sadly there are many thousands (millions) of women who have been surgically castrated at a young age and were not offered therapy for the negative metabolic and psycholigical effects of estrogen depravation. It is sad to contemplate the suffering of a woman in her 20's-40's with hot flashes, insomnia and thin/broken bones. The photo you refer to could very well be one of those.

      October 6, 2013 at 11:29 | Report abuse |
    • Dug

      Laurie, sadly there are many thousands (millions) of women who have been surgically castrated at a young age and were not offered therapy for the negative metabolic and psycholigical effects of estrogen depravation. It is sad to contemplate the suffering of a woman in her 20's-40's with hot flashes, insomnia and thin/broken bones. The photo you refer to could very well be one of those.

      October 6, 2013 at 11:29 | Report abuse |
  7. KarenW

    Trotting out the same dated studies and claiming that risks are too high for many. These studies had no information about transdermal HRT and the data gathered from them didn't consider age when HRT was started. They are just covering their asses because new information and calculations show that as many as 50,000 women's lives could have been saved by using estrogen alone–women who had a hysterectomy. When will they stop backtracking and justifying flawed studies?

    October 2, 2013 at 09:16 | Report abuse | Reply
  8. Sherri

    HRT is not for everyone. I have fairly bad symptoms, but when I recently tried to go back on HRT, I went into a deep depression that last several months. It was the HRT side effects. So while I was not having hot flashes, or night sweats and did sleep better, during the day I was so depressed that I could not get out of my chair. Had to stop them. Even tried a second type and it did not help. So while I do not FEAR HRT as some do, I simply cannot take them anymore.

    October 2, 2013 at 17:58 | Report abuse | Reply
    • Dee914

      I had this same problem with depression. I realized after trial and error that it was the progesterone. I'm very sensitive to it for some reason. Makes me very depressed and sleepy. Even the over-the-counter cream makes me depressed! I dropped the progesterone and just take estrogen now. I sleep so much better on it, have no hot flashes, and better temperment.

      October 4, 2013 at 12:05 | Report abuse |
  9. Galina L.

    I have a very good guess why you felt depressed on HRT – I bet it was mostly progesteron and a little bit of estrogen in your prescription. It is another problem with HRT – doctors prescribed disproportional amount of progesteron out of scare of estrogen(due to that stady about HRT). How many of us feel sub-optimal, hungry all the time and prone to crying at the second half of a menstrual cycle when progesteron is high ? It gives a good hint.

    October 2, 2013 at 20:04 | Report abuse | Reply
  10. boungiorno

    they didnt have all these hormone drugs 200 years ago and sure there r pro's and cons to everything just look at what you eat and wear and touch and how it is processed and you will find your answer to all these illnesses, FOREIGN PARTICLES.

    October 3, 2013 at 02:42 | Report abuse | Reply
    • Dee914

      There is some truth to this. I went on a very strict no sugar, no white flour diet once and it basically cured my menopause symptoms. I wasn't eating any processed foods either.

      October 4, 2013 at 12:06 | Report abuse |
  11. boungiorno


    October 5, 2013 at 06:17 | Report abuse | Reply
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    Hi I'd like to RSVP. See you later today. Thanks,


    November 13, 2013 at 17:33 | Report abuse | Reply
  13. Alora Mackenzie

    Hormone therapies for prostate cancer cause side effects because they reduce the levels of male hormones in the body. Some side effects are common to all hormone therapies used for prostate cancer. Some effects vary from drug to drug.

    November 19, 2013 at 02:09 | Report abuse | Reply
    • smith

      IF you post a link then post like this
      Prime Body.com

      November 22, 2013 at 07:13 | Report abuse |
  14. David

    Alora Mackenzie is 100% right. Hormone Replacement Therapy is about hormone optimization and BALANCE. You can't supplement with estrogen and progesterone and expect testosterone levels to magically follow suit on their own. Furthermore, I didn't think I would find anymore articles with postings past 2013 that neglect the fact that the WHI studies only used synthetic hormones and not Bio Identical ones. There is a big difference in the two, especially when addressing potential health concerns. Look at Dr. Shira Millers article here on why not to worry about bio identical hormone replacement: http://studiocity.patch.com/groups/shira-miller-mds-blog/p/bp–10-reasons-not-to-worry-about-bioidentical-hormon4152e0b203 . Kudos Shira! You can also find more information about female hormone replacement therapy at http://www.agemanagementoptimalwellness.com/womens-estrogen-progesterone.html .
    Or about estrogen dominance (i.e. female hormonal imbalance) here: http://agemanagementoptimalwellnesscenters.com/female-hormones/estrogen-dominance .

    Hope this was helpful for some of you. : )

    December 6, 2013 at 14:44 | Report abuse | Reply
  15. T Anguish

    There have been numerous ads recently regarding Premarin. Premarin is a hormonal type drug for menopause and uses the urine from pregnant mares. A horse’s pregnancy goes for almost 11 months so you can imagine what Premarin horses go through.

    This is not to down play the huge vital role that medications have in our lives but on the other hand the way they obtain the drug is horrible. These horses should never be treated this way. One should be aware as to what goes into the making of the Premarin drug. There are other alternatives including a synthetic version of Premarin.

    Pregnant mares used for Premarin® production are confined to narrow tie stalls where they cannot turn or lie down for weeks at a time without release for exercise. Regulations only require that the mares be turned out for two hours every two weeks. This chronic lack of exercise can cause severe swelling of the legs, breakdown of the hoof structure and sets the stage for colic.

    What most women do not know is that one statistic shows 40,000 mares per year are used to produce Premarin. These horses live lives filled with suffering: they are kept continually pregnant in stalls too small for them to turn around with catheters inserted to drain their urine. When they can no longer reproduce or they become lame, they follow their foals to the slaughterhouse; their meat is then sold for human consumption or dog food.

    One of the sites literally shows a foal hanging by its two back legs from a chain getting slaughtered. Warning: The links are graphic and heart wrenching as to what 2 legged mammals do in the name of "relief". The pictures, etc. will be upsetting for those that have no stomach for 4 legged mammal abuse.




    PLEASE STOP USING THIS DRUG. Voice your concern and outrage to Pfizer and let your family and friends know about the horror that goes into making this "drug" We need to stop manufacturing this drug and stop this practice.

    June 13, 2014 at 18:47 | Report abuse | Reply
  16. jen

    http://test-at-home.salivatesting.com/ is a great place to get affordable hormone saliva testing kits. plus their video is hilarious.

    August 5, 2014 at 22:42 | Report abuse | Reply
  17. kentonscott

    Nice information. There are so many benefits of hormone replacement therapy so, don't worry just experience it. You will see changes yourself. It is very beneficial for both men and women.

    September 4, 2014 at 07:42 | Report abuse | Reply
  18. kentonscott

    Thanks for nice information.
    There are a lot of benefits of hormone replacement therapy so don't worry, just go for it. You will experience a change in your life.

    October 8, 2014 at 01:31 | Report abuse | Reply
  19. asenathdidit

    This is a great article as it talks about some of the studies done on hormone replacement therapy, bringing out potential side effect and the benefits. We do bioidentical hormone replacement therapy instead of synthetic hormone replacement therapy because of even fewer side effects. There is more info on BHRT here... http://goo.gl/SrZNOY

    December 17, 2014 at 15:06 | Report abuse | Reply
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