Ask the Doctor at Saint John’s: What Are the Health Risks of Hormone Therapy?

Q: Help! I’m going through menopause, but I’m not sure if it is safe to take estrogen to control my symptoms. What’s the latest word on hormone therapy?

A: By Amy E. Rosenman, M.D., urogynecologist at Saint John’s Health Center

From the ages of 45 to 55, most women begin experiencing symptoms of menopause – insomnia, hot flashes, night sweats and vaginal dryness. Traditionally, these symptoms were treated with hormone therapy (HT), which is a combination of estrogen and progesterone.

Three years ago, many women stopped taking hormones to control their menopausal symptoms after a federally funded study, the Women’s Health Initiative, found that there was a very slight increase in the number of heart attacks in women who took estrogen and progesterone. The study also found that estrogen and progesterone raised the risk of breast cancer.

As a result, many women became frightened and discontinued their HT. Interestingly, women with a prior hysterectomy on estrogen therapy alone did not have increased risks of heart attacks or breast cancer. The risks were seen only in those on combined HT.

The risks of heart attack and breast cancer are quite small, however. For example, among the women in the study who didn’t take HT, 30 out of 10,000 had a heart attack. Among the women studied who did take HT, 37 suffered a heart attack – a difference of only seven women out of 10,000, which is miniscule.

About 60 to 70 percent of women have such mild menopausal symptoms that they don’t need HT, and these women were happy to discontinue the treatment when the study came out. But an estimated 20 percent of women continue to suffer some menopausal symptoms for longer than five years, and more of these women have resumed taking HT.

In addition to effectively treating menopausal symptoms, there are other benefits of HT. Estrogen reduces osteoporosis and the incidence of colon cancer, for example, and even lowers the amount of LDL (“bad”) cholesterol in the bloodstream.

While I don’t advocate HT for everyone, I encourage women suffering from menopausal symptoms to talk with their physician about the risks and benefits of taking hormones. The risk of heart attack and breast cancer from HT are quite small, and women suffering from debilitating symptoms should not be afraid to seek care.

The majority of women don’t need HT or estrogen therapy, but for those who do, they should be reassured that it is relatively safe. Please visit your physician and discuss your individual needs prior to making a decision about hormones.

Dr. Amy Rosenman is a gynecologist and urogynecologist at Saint John’s Health Center in Santa Monica. For more information about Saint John’s services, please call (310) 829-8990. For a physician referral or a second opinion, please call 1-888-ASK-SJHC or visit the website at www.stjohns.org.

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