Hormone therapy used to be widely regarded as a very safe treatment for menopause. However, several major studies have shown that hormone therapy creates risks for certain medical conditions and problems, including heart disease, stroke, and cancer.

However, hormone therapy may help relieve some of the bothersome symptoms of menopause, such as hot flashes, vaginal dryness and pain with intercourse, and long-term complications of estrogen loss, such as osteoporosis.

You and your doctor should decide whether hormone therapy is right for you. The key is to weigh the risks associated with taking hormone therapy against your risk of heart disease or osteoporosis without taking hormone therapy. Every woman is different. Your doctor should be aware of your entire medical history when considering prescribing hormone therapy.

At this time, short-term use (up to 5 years) of hormone therapy at the lowest possible dose to treat the symptoms of menopause still appears to be safe for many women.

BENEFITS OF HORMONE THERAPY

Perhaps the largest benefit women receive from hormone therapy is relief from:

  • Hot flashes
  • Night sweats
  • Sleep difficulties
  • Vaginal dryness
  • Anxiety

Usually, hot flashes and night sweats are less severe after a couple of years, especially if hormone therapy is slowly reduced.

A woman’s body produces less estrogen during and after menopause, which may affect her bone strength. Hormone therapy may also prevent the development of osteoporosis. For information on treating bone loss, see: Osteoporosis. Studies have not been able to definitely show that hormone therapy helps with urinary incontinence, Alzheimer’s disease or dementia, or colon cancer.

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RISKS OF HORMONE THERAPY

BLOOD CLOTS

Doctors have long known that taking estrogen increases a person’s risk for blood clots. Generally, this risk is higher if you use birth control pills, which contain high doses of estrogen. Your risk is even higher if you smoke and take estrogen. The risk is not as high when estrogen skin patches (transdermal estrogen) are used.

BLOOD CLOTS

CANCER

Breast cancer: Woman who take estrogen therapy for a long period of time have a small increase in risk for breast cancer. Most guidelines currently consider hormone therapy safe for breast cancer risk when taken for up to 5 years.
Endometrial/uterine cancer: The risk for endometrial cancer is more than five times higher in women who take estrogen therapy alone, compared with those who do not. However, taking progesterone with estrogen seems to protect against this cancer. Endometrial cancer does not develop in women who do not have a uterus.

CARDIOVASCULAR DISEASE

Heart disease: Estrogen may increase the risk of heart disease in older women. However, it may still be somewhat protective in preventing heart disease when given under certain circumstances. Estrogen is probably the safest for women under 60 years of age.

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