AILSA CHANG, HOST:
A study published today in the medical journal JAMA finds that women under 60 can safely take hormone therapy to treat symptoms of menopause. This is very different from the advice that women were given 20 years ago. NPR's Allison Aubrey reports on what's known now that wasn't known then.
ALLISON AUBREY, BYLINE: Twenty-two years ago, a large study of thousands of women taking hormone replacement therapy led to some very unexpected results. Women taking Prempro, which is a combination of estrogen and progestin, turned out to have a higher risk of breast cancer and stroke. Dr. JoAnn Manson is chief of preventive medicine at Brigham and Women's Hospital.
JOANN MANSON: The findings were surprising, but the reason the randomized trial was conducted was because the answer was not known.
AUBREY: After this, many women abruptly stopped the therapy, and the study was halted. Twenty years later, many healthcare providers still hesitate to recommend hormone therapy, even though a lot has changed. There are different types of hormones delivered at lower doses that are shown to be safer. The new analysis based on two decades of follow-up adds to the evidence that hormone therapy can be beneficial.
MANSON: Among women below the age of 60, we found menopausal hormone therapy has low risk of adverse events and would be safe for treating bothersome hot flashes, night sweats and other menopausal symptoms.
AUBREY: And the benefits may go beyond that, says Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. She says the risks identified 20 years ago in the Women's Health Initiative had a lot to do with the hormones given to the women, including the type of progestin.
LAUREN STREICHER: What we now appreciate is that medroxyprogesterone acetate was highly problematic and, in fact, was what was responsible for that slight increase that was seen in breast cancer. So we don't prescribe that anymore. Now we prescribe other progestogens, such as a micronized progestogen, which do not increase the risk of breast cancer...
AUBREY: And may help protect against cancer in some women. Dr. Streicher says the risk of pulmonary embolism in the study was likely linked to the fact that women took estrogen orally. She says a better option for people at risk of clots is to take estrogen through the skin, with a patch, a cream, or gel.
STREICHER: The advantage of a transdermal estrogen is that it is not metabolized by the liver. And because it's not metabolized by the liver, we don't see that increase in blood clots.
AUBREY: With a range of hormone therapies available now, Dr. Streicher says there's not a one-size-fits-all approach.
STREICHER: Hormone therapy is beneficial way beyond the benefit to just helping with hot flashes.
AUBREY: Ongoing research points to protection against bone loss, and it may help protect against heart disease, too.
Allison Aubrey, NPR News.
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