In the wake of recently released findings from a National Institute of Health study, millions of women are naturally confused about the use of hormone replacement therapy (HRT) for menopausal symptoms and the risks that may or may not be involved.

The NIH study, which involved more than 16,000 women, was discontinued due to findings of increased health risks, including heart attack, strokes, blood clots and breast cancer, after long-term usage in women who took estrogen plus progesterone (the drug commonly prescribed as PremPro). 

So what should women on HRT do?  First and foremost, don’t panic.  This is not a drug recall or an emergency medical alert, although the implications are important and shouldn’t be ignored.  Talk with a qualified physician about your individual situation. 

It’s also important to understand  some key points about these research findings .  First, these findings do not apply to women who have had their uterus removed by hysterectomy and are taking only estrogen (usually prescribed as Premarin, Estrace, Ogen or Estradiol).  Second, the researchers involved in the study took great pains to emphasize that women should not be unduly alarmed, and the results should be considered in context.. The danger to an individual women is small, but small risks can have large consequences when the large population taking the therapy is considered.   For example, the increased risk of breast cancer for an individual women taking the combination therapy is less than a tenth of one percent per year.  The population risks, applied over several years to millions of women, make the increased risks an important public health concern.

The major benefit of HRT is to treat the hot flashes and other immediate symptoms of menopause.  There is a general consensus among researchers that short-term HRT to relieve hot flashes and other temporary menopause-related symptoms is probably safe, with the benefits during this short time period (up to five years) outweighing the risks.  Women who have been on the combination HRT for a number of years should talk to their doctor about tapering off the medication and substituting alternative strategies to deal with menopausal symptoms.  Women who are just beginning menopause and considering HRT should take into account the research findings and evaluate their risks versus benefits, as well as treatment alternatives, in consultation with their physician.  Remember, any decision about HRT should take into account a women’s individual risk for specific conditions that may be harmed or benefited by hormone use. 

Menopausal symptoms can be alleviated without taking hormones in many cases.  Lifestyle changes, supplements and other medications can often successfully combat the symptoms and increased health risks associated with the onset of menopause:

Risk of osteoporosis (bone loss and weakness):  weight-bearing exercise, calcium supplements, prescribed medication Fosamax 

Risk of heart disease:   stop smoking, eat a diet low in fat, exercise regularly, lipid-lowering drug Lipitor

Mood swings: get adequate rest, exercise regularly, the herb black cohosh

Hot flashes: add soy products to your diet, black cohosh, decrease the amount of spicy food, caffeine and alcohol in your diet 

Insomnia: over-the-counter sleep aids like Tylenol PM and Unisom are often helpful and are not addictive

Making a decision about HRT is one of the most important health decisions a woman will make in her lifetime.   Every woman experiences menopause differently and her treatment should be tailored to treat her specific symptoms.  A very positive outcome of the NIH research results will be increased communication between women and their physician, and a more individualized approach to treatment that will be even better for women’s health in the long term.