Women's Health Initiative (WHI) study

In simple terms: The Women's Health Initiative found that long-term use (five or more years) of hormone replacement therapy (HRT) combining two hormones, estrogen and progestin, increased women's risk of heart disease, stroke, blood clots and breast cancer. The hormones lowered women's risk of bone fractures and colorectal cancer.

What about the benefits of HRT? How do these numbers relate to your personal decision? Every woman is unique and no one should start or stop medication without consulting with her doctor. That said, here are questions and answers that may help you and your doctor arrive at a decision.


Q. So why did we ever begin prescribing HRT to prevent heart disease? 

The latest research clearly indicates that HRT does not prevent heart disease. The practice began because observational studies found that women taking HRT tended to have lower rates of heart disease, stroke, colon cancer and osteoporosis. It now appears, at least in terms of cardiovascular disease, that these women may simply have been healthier and more likely to see a doctor. The best advice is to reduce known risk factors. Quitting smoking, losing weight, as well as controlling cholesterol and blood pressure, will help reduce the risk of heart disease.

Q. What about HRT to prevent the symptoms of menopause?

Not all women experience symptoms such as hot flashes, night sweats or mood swings during menopause. Those who do usually have the symptoms for just a few years. If you have severe symptoms and don't have breast cancer, hormones are probably fine. Most experts today say the benefits of HRT outweigh the risk if hormones are taken for a brief period of time (1-3 years.)

If you have been on HRT for several years or if you started HRT before ever experiencing bothersome symptoms, consider talking with your doctor about tapering off the hormones. You may be surprised; the symptoms you dread may not affect you at all. The majority of women (70-80%) will have no symptoms or mild ones, while 20% to 30% have symptoms severe enough to warrant medication.

Most doctors caution against stopping HRT "cold turkey," since this may cause symptoms
to return. For example, Laura Corio, MD, author of The Change Before the Change, recommends her patients taper off by taking the hormones every other day for two weeks and then stopping completely.

Q. What's the difference between the pill and HRT?

The answer is dosage. HRT has only one-quarter to one-eighth the amount of estrogen and progesterone as the birth control pill. The lower the dosage of these hormones, the fewer the side effects.

If you're having bothersome hot flashes but still having occasional periods and want to take estrogen, it's better to take the pill than HRT," says Lynne Shuster, M.D., a specialist in internal medicine at Mayo Clinic, Rochester, Minn.


Q. What about HRT to prevent osteoporosis?

Research shows that HRT does lower a woman's risk of bone fractures. If you are taking HRT to prevent osteoporosis, discuss your family history and treatment options carefully with your doctor. Is your risk for osteoporosis significantly greater than your risk for heart disease or breast cancer? Discuss other treatments that could help preserve bone health without the risks of HRT, such as diet and weight-bearing exercise.


Q. In light of recent WHI and other findings, what are some alternatives?

Low-dose HRT: Some doctors believe that lower doses of HRT can offer the benefits without the risks. Studies do indicate that lower doses of estrogen and progestin (about half the dose as in Prempro) can relieve hot flashes and vaginal dryness. Theoretically, lower doses may pose less risk to breast tissue and heart health but studies have not
yet been done.

Soy protein: Studies of soy protein show varying results in reducing blood pressure and
LDL cholesterol in postmenopausal women. Soy has been advocated by some to be an effective short-term treatment to quell hot flashes and night sweats. However, recent studies suggest that soy may not actually reduce hot flashes in the majority of women. Women with a history of estrogen-dependent cancer of the breast, uterus or ovaries
should consult with their physician before adding soy supplements to their diet.


Black cohosh: Black cohosh (cimifuga racemosa) is a member of the buttercup family
and is native to the woods of eastern North America.  Its roots contain phytoestrogen compounds. Known as squawroot by American Indians, black cohosh was used to treat female complaints and as an insect repellent. A study published March 28, 2002, in the Journal of Women's Health and Gender-Based Medicine found that black cohosh extract reduced symptoms
in 70% of women but some studies have shown less dramatic results. Black cohosh is not recommended for use by pregnant or breast-feeding women.

Calcium and vitamin D supplements: Older women and men should get about 1,500 mg a day of calcium. Dietary sources of calcium include fat-free milk, yogurt and cheese. Also, eating more protein could help the body effectively absorb calcium and vitamin D, according to one recent study at Tufts University in Boston. Elderly people who took 500 mg supplements in addition to dietary calcium and ate about 80 grams of protein
a day - had better bone mass than those in the control group.


Lifestyle changes: Limiting salt in the diet - and walking at least 30 minutes a day - can also lower blood pressure in postmenopausal women by a surprising amount, according to a study published in the August 2001 Journal of the American College of Cardiology. In the study, those who ate only a teaspoon of salt a day and walked, lowered their blood
pressure by 16 points. To lower sodium in your diet, cook with less salt, use herbs and lemon juice to flavor foods, check packed food labels for sodium and limit salty snack foods.

Exercise: Remember, 30 minutes of weight-bearing and strength-training exercise - even for women in their 70s, 80s, 90s, and older - can build bone. It's one of the most natural remedies and one that will also help maintain a woman's overall health.

Q. If I'm a woman approaching menopause, what should I do?  

First, you may want to wait to see what symptoms you experience and how severely they affect your life. Remember, some studies indicate that only 50% of women suffer significant hot flashes, mood swings or night sweats and those symptoms usually last just three to four years.

If symptoms do cause you problems, talk with your doctor about lifestyle changes you can consider. Among them: Regular exercise, cold beverages, limiting caffeine and alcohol, relaxation techniques such as yoga and dressing lightly in natural fabrics.

If you're still uncomfortable, talk to your doctor about your individual risk from taking HRT for a limited period of time. Remember, each woman's risk is different, based on her family history of cancer and heart disease.