Estrogen and progesterone are female hormones produced by the ovaries. When women reach menopause, the production of these two hormones progressively decreases and eventually stops. However, when the ovaries are surgically removed, the production of these hormones stops abruptly. The loss of estrogen, whether it occurs naturally or as a result of surgery, produces symptoms which may be uncomfortable. These symptoms include:
- Hot flashes
- Sleep disturbances
- Irritability
- Vaginal dryness, which may cause discomfort during intercourse
Hormone therapy (HT) may be recommended to provide relief of menopausal symptoms. Hormone replacement therapy usually refers to some combination of estrogen and progesterone.
It was felt in the past that HT provided significant protection against heart disease. Heart disease is the number one killer of women. HT was also recommended to women to protect against osteoporosis.
However, in 2002, the Women's Health Initiative Study, a study of over 16,000 women, concluded that:
- There was a significant increase in heart attack, stroke and blood clots in women who use combined estrogens and progestins (37 had a heart attack compared to 30 out of every 10,000 women taking placebo pills; 29 had a stroke each year, compared to 21 out of every 10,000 women taking placebo pills; 34 had blood clots in the lungs or legs, compared to 16 women out of every 10,000 women taking placebo pills.)
- There was a significant increase in breast cancer in women who use combined estrogens and progestins 38 developed breast cancer each year compared to 30 breast cancers for every 10,000 women taking placebo pills each year. Estrogen alone hormone therapy did not increase the risk of breast cancer.
- These effects occurred in women taking the combination of estrogen and progesterone for greater than five years.
- There was a significant decrease in osteoporosis and colorectal cancer in women who use combined estrogens and progestins.
Since the results of the WHI were published, other researchers have reviewed the study and noted that the women in the study had an average age of 63 and an average BMI of 28, both of which will increase the risk for heart disease.
Current recommendations are that hormone therapy should be used to treat menopausal symptoms such as hot flashes, night sweats and vaginal atrophy using the lowest dose possible for the shortest amount of time.
For more information, visit these sites:
American College of Obstetricians and Gynecologists
North American Menopause Society
Food and Drug Administration
NIH Menopausal Hormonal Information
The National Women's Health Information Center
Last Updated: September 24, 2009