In the 1980’s and 1990’s, hormones were prescribed liberally by physicians. The data supported this. Women were living longer, and were more likely to suffer from cardiovascular disease and osteoporosis. The studies demonstrated that women did not develop heart disease until after menopause. Hormones were given in cyclic fashion, in an effort to simulate menstrual cycles, and women had “periods” into their sixties and seventies. Then the practice changed. As doctors realized that 60 year olds did not want to continue having cycles, the standard became continuous hormone replacement. The same dose of estrogen and progesterone were given daily. Hormone levels remained even, which is a good thing, and there was no bleeding.
In 1994, the National Institute of Health began a study to see if giving older women hormones would reduce their risk of heart disease. Since about 1/3 of women die of cardiovascular causes, maybe giving hormones to the most vulnerable women would protect them. Hormones seemed to be protective for women in their 50’s, so physicians at the NIH expected that it would protect older women, too. The Women’s Health Initiative was a huge study, that double-blinded women to take conjugated equine estrogen .625 mg, or placebo. Women enrolled in the study were as young as 50 and as old as 80. The study was stopped in 2002, abruptly, because the early data was unexpected.
Although hormones reduced the risk of colon cancer and osteoporotic fractures, it increased the risk of breast cancer, deep venous thrombosis (blood clots), strokes and heart attacks. It was not the result that was expected. When the researches added the benefits and risks, it seemed that there were more risks than benefits. The press sensationally reported the information, patients were very upset and conflicted, and doctors were deluged with patient calls. It took some time to sort out the findings, but, after years of follow up, most gynecologists altered their prescribing practices.
It was unfortunate that the study did not take into consideration quality of life and sexual function, which are important factors in a woman’s decision making process. Hormone replacement is the most effective treatment for menopausal symptoms. For women under age 60 or within 10 years of menopause, in most cases, the benefits outweigh the risks. Doctors now usually prescribe the lowest dose that will manage symptoms. Many women are afraid of taking estrogen, and may tolerate years of bothersome symptoms. It just isn't necessary!
But things are changing again. The data has been examined and re-examined. Re-analysis of many previous studies demonstrate that hormones are very, very safe for women in their 50's, within 10 years of menopause. Actually, women who take hormones in their 50's are 30% less likely to die of all causes. If you take hormones in your 60's, there is no increase or decrease in all causes of mortality. Decisions certainly need to be individualized. Read on, and you will learn more....