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Menopause and old age

Older women at menopause

RT or hormone replacement therapy has suffered a highly publicized setback.

The National Heart, Lung, and Blood Institute of the National Institutes of Health announced that the Women's Health Initiative (WHI) study; evaluating combined estrogen and progestin use in postmenopausal women was halted. The healthy postmenopausal women in the halted segment of the WHI series of randomized trials were taking what is called combined hormone replacement therapy. The women had an intact uterus and were receiving two hormones Premarin (a specific brand of estrogen) and progesterone. After a review of early data, the study safety monitoring board concluded that the risk of combined HRT use in this study population outweighed the benefits. However the other part of the study, women who had had a hysterectomy and were taking estrogen alone is continuing. The study reported if 10,000 women take the hormones for one year, are compared to 10,000 women who don't, in the hormone group, eight more will develop invasive breast cancer, seven more will have heart attacks, eight more will have strokes and eight more will have blood clots in their lungs. The benefits were six fewer cases of colorectal cancers and five fewer hip fractures. Clearly the risks outweighed the benefits.
So what should the estimated six million American women who are taking HRT do? Taking into consideration that significant risk was observed after an average of 5.2 years of use; short-term use to treat hot flashes and night sweats may be appropriate. In a press release by Wyeth the manufacturer of the combined HRT used in the study, Dr Victoria Kusiak, vice president of clinical affairs stated that even though the studies findings were significant we need to recognize ""the critical role combination HRT plays in… [treating the symptoms of menopause] for healthy women beginning therapy in early menopause"". Her sentiments were echoed in a statement by the American College of Obstetricians and Gynecologists (ACOG) ""Hormone replacement therapy for the treatment of acute menopausal symptoms, when indicated, continues to be appropriate for short-term use without an apparent increase in risk of breast cancer for up to 4 years."" Dr. Jacques Rossouw, a study author commented that in women already taking combination HRT for short-term relief of menopausal symptoms ""the benefits are likely to out weigh the risks"".
The consensus seems to be, if you are already on HRT or suffering from hot flashes and night sweats, short term (4 years or less) of HRT seems safe and effective.
If you don't have a uterus, because you have had a hysterectomy, you can continue on HRT.
If you are taking HRT for more than 4 years for the symptoms of menopause your doctor will probably recommend an alternative treatment. Treatments can include antidepressant drugs herbs such as black cohosh, soy foods or high dose vitamins. ACOG also recommends:

 

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