WOMEN'S HEALTH: HORMONE REPLACEMENT
WOMEN'S HEALTH INITIATIVE AND HORMONE REPLACEMENT THERAPY: QUESTIONS AND ANSWERS
What is the Women's Health Initiative (WHI)?
It is a large study that was initiated by the National Institutes of Health in 1993 to evaluate the effects of postmenopausal hormone replacement therapy on healthy women. On 7/9/2002 the study researchers published new information that changes some of our understanding about the risks and benefits of estrogen and progesterone. The study has shown that women taking the combination of estrogen and progesterone have a small increased risk of heart attack, stroke and breast cancer. The study also confirmed that there appear to be several health benefits of taking the two hormones--specifically a decrease in colon cancer and hip fractures. However, the researchers believe the risks outweigh the benefits especially for women who have taken the estrogen and progesterone for more than five years.
What are the risks of having a heart attack or stroke or getting a breast cancer if the estrogen and progesterone has been taken more than five years?
Your individual risk cannot be determined with certainty, but the WHI participants were healthy women aged 50-79 (average age 63) who had been using the estrogen and progesterone for more than five years. Among these women, 1.9% had a heart attack during those five years compared with 1.5% for women not taking the hormones. The breast cancer and stroke risk were similarly increased over a matched group of women not taking the hormones. These are small individual risks but in our population, over time, become a significant number. The study suggests for every 10,000 women taking estrogen and progesterone for one year the following increases and reductions in risk would be expected:
- 7 additional heart attacks or heart disease deaths
- 8 additional strokes
- 18 additional serious blood clots
- 8 additional breast cancers
- 6 fewer colon and rectal cancers
- 5 fewer hip fractures
What should I do if I am taking estrogen and progesterone?
Think about your reasons for taking hormones and whether you wish to continue. The decision is not urgent and it should be made thoughtfully. Women who have been taking both estrogen and progesterone for more than five years may want to consider stopping therapy and can safely do so on their own. Others may decide the benefits for them outweigh the risks. If you are being treated for osteoporosis with hormones, have a significant family history of colon cancer or have any questions about your particular situation, talk with your primary care provider or gynecologist about whether to continue therapy with hormones.
What should I do if I have menopausal symptoms such as hot flashes, mood changes, or night sweats?
We know that HRT, with or without progesterone is the most effective treatment for menopausal symptoms. It seems the risks of taking estrogen and progesterone are related to the amount of time a woman is exposed to the hormones. Women who are taking or considering taking hormones need to weigh the small personal risks against their discomfort from menopausal symptoms.
If I decide to stop hormones, how should I do it?
You can safely stop both estrogen and progesterone all at once. Most women will probably have no effects from stopping their pills. Some women may have menopausal symptoms of hot flashes, night sweats or mood changes. These are normal and should decrease quickly over time. Tapering the dose of the hormones may decrease the symptoms. For instance, cut your usual hormone pills in half and take half the dose for a few weeks to a few months. Then try taking your dose every other day for the same period of time and stop. Some women will experience several days of vaginal bleeding within a week or two of their last dose or while tapering their dose. This is normal and you do not need to call your provider unless the bleeding is prolonged. Long term effects of stopping hormones may be vaginal dryness, urinary tract changes (bladder irritation and incontinence), changes in libido (sexual desire), and skin changes.
What should I do if I am taking just estrogen because I have had a hysterectomy?
The WHI has not found the same breast cancer risk for women who are taking estrogen alone. Progesterone is prescribed with estrogen to help prevent cancer of the uterus. At this time it is not advised that you stop taking your medication if you are only taking estrogen. It is also not advised for women with a uterus to stop taking the progesterone and take only estrogen to lower their breast cancer and heart attack risk; the risks of developing uterine cancer outweigh the benefits.
What should I do if I have been using an estrogen patch or estrogen cream?
The WHI has not specifically addressed either of these treatments. The estrogen patch when used with progesterone may increase the risk of heart attack, stroke, or breast cancer but this is not known at this time. Estrogen cream is most likely a safe treatment for vaginal dryness since so little of the hormone is absorbed into the bloodstream.
What about birth control pills or "natural" estrogen and progesterone?
Birth control pills have not been shown to increase a woman's risk of breast cancer. There is no change in the recommendation for the use of birth control pills before menopause. There are no studies to show other forms of estrogen and progesterone are safe or harmful.
To find out more detailed information, visit the WHI website at www.whi.org or find information on the North American Menopause Society web site at www.menopause.org . If you have questions about your medications and whether you should continue to take them, please make an appointment with your health care provider. back to top
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