Study: Hormone Therapy is Safe and Effective For Menopause Symptoms

• A follow-up analysis finds that hormone therapy is effective for women under 60 experiencing menopausal symptoms.
• Researchers also concluded that the risk of developing breast cancer and other conditions from taking hormone therapy is low for this age group.
• The new study reverses some of the conclusions of the Women’s Health Initiative, a study that made doctors and the general public skeptical about hormone therapy.

The benefits of taking hormone therapy to ease menopause symptoms outweigh the risks for women under 60, researchers reported recently in the journal JAMA.¹

The findings are based on nearly two decades of follow-up data from the Women’s Health Initiative (WHI) study, which challenged the safety of hormones and led to millions of women stopping treatment.² 

The new analysis reverses some of those findings and builds on previous research finding hormone therapy to be safe and effective.

“Hormone therapy is effective in reducing menopause symptoms, without question,” Garnet L. Anderson, PhD, co-author of the study and senior vice president and director of the Public Health Sciences Division at the Fred Hutchinson Cancer Center, told Health. “But there are risks and benefits of hormone therapy for both types of hormones that we tested.”

The Study That Sparked the Hormone Debate

In the 1990s, researchers enrolled more than 160,000 postmenopausal women between the ages of 50 and 79 in the WHI to better understand how hormone therapy helped menopause symptoms.²

The researchers halted the study after they found that women taking Prempro, a combination of estrogen and progestin, had higher risks of breast cancer, stroke, cardiovascular disease, and pulmonary embolism.

As a result, many women and medical professionals became skeptical and cautious about hormone therapy.

“The WHI is the reason why most doctors today don’t prescribe hormone therapy, and most women don’t take it even though multiple subsequent analyses of the WHI pointed out the flaws in the study that skewed the data,” Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, told Health.

One of those flaws is that the study included mostly women over 60 and glossed over the more positive outcomes that younger women enrolled experienced.

The fallout from the study “was a terrible disservice to a huge population of women who suffered unnecessarily from the symptoms of menopause and who then experienced increases in the conditions that can be prevented by the appropriate use of HT,” Lisa Brent, ND, founder and medical director of Be Well Natural Medicine and menopause specialist, told Health.

What Did the New Study Find?

In their follow-up analysis, researchers found that hormone therapy doesn’t lower the risk of heart disease, stroke, or dementia for women under 60, as some studies have suggested.

However, hormone therapy wasn’t particularly risky for this population either. For example, there was less than one extra stroke case per 1,000 younger women using estrogen-progestin therapy and no additional risk with estrogen alone.

Taking hormone therapy also resulted in improved moderate-to-severe night sweats, hot flashes, and other menopausal symptoms.

“Other risks, mostly cardiovascular diseases and breast cancer, are in general very small in this age group, so the benefit for symptom relief may outweigh these risks,” Anderson said. “The risks of these diseases increase with age, so these adverse effects also become more prominent in later ages.”

The study also looked at outcomes unrelated to hormone therapy.

Researchers concluded that calcium and vitamin D supplements shouldn’t be recommended for fracture prevention in postmenopausal women. However, they did find that the vitamins could help fill nutrition gaps for women who don’t get enough in their diet.

Additionally, researchers found that a low-fat diet with more fruits, vegetables, and grains did not reduce the risk of breast or colorectal cancer. It was, however, linked to a lower risk of dying from breast cancer.

Anderson said limitations of the study included not testing all types of hormone therapy preparations and not including women who went through menopause prematurely due to conditions like surgery or chemotherapy.

“We also did not recruit women with menopausal symptoms as our purpose was not to establish their efficacy for symptoms, but rather to consider what had become an increasingly common practice in the 1990s of putting women on hormone therapy long-term for disease prevention,” Anderson said.

What Experts Think About the Findings

Meleen Chuang, MD, a clinical associate professor in the Department of Obstetrics and Gynecology at NYU Langone, told Health that the findings are significant.

“I am happy they have been updated to reflect hormones are safe for menopausal women under 60 years of age,” she said. “The field of menopause research is continuously evolving—some next steps for this type of research may involve further investigation into the benefits and risks of hormone therapy, exploring alternative treatments, and studying the long-term effects of hormone therapy on different populations, possibly by race.”

Streicher, however, took issue with the finding that hormone therapy doesn’t help reduce the risk for aging-related health problems.

“In this analysis, the authors inexplicably come to the conclusion that hormone therapy should only be prescribed in early menopause to help with moderate to severe hot flashes and night sweats and should not be used to prevent heart disease, stroke, dementia, or other chronic diseases,” she said. “The conclusions and recommendations made in this new analysis contradict their own data and make no sense—but most of all are harmful to women.”

Streicher pointed out that the study makes no mention of research showing that women who take hormone therapy have a 33% decreased risk of developing uterine cancer and show improvements in mood, sleep, sexual function, joint pain, and cognitive function.³

What to Do If You’re Interested in Hormone Therapy

If you’re curious about or interested in hormone therapy, it’s worth seeking out information—regardless of your age. Brent said the first step is to consult with an OB/GYN specializing in menopause care.

“Not all doctors are up to date on the current recommendations and researched-based guidelines for menopause treatment, so women need to find someone who is,” Brent said. “Don’t take no for an answer.”

There isn’t a one-size-fits-all approach to menopause treatment, she added. During an appointment, a doctor can assess your risk factors and symptoms and determine the right strategy for you, whether that’s hormone therapy or an alternative.