Detection of Red-Hot Hormone

Wouldn’t it be fabulous to eliminate menopause altogether? Until recently, hormone therapy (HT) promised to do that and more. Doctors said the fountain-of-youth pills would not only indefinitely postpone hot flashes, night sweats, and vaginal dryness, but also safeguard your bones and heart from disease. Then came the disappointing results from a landmark study, the Women’s Health Initiative (WHI), in 2002. Researchers reported that supplementation with estrogen and progestin actually raised the risk of both heart disease and breast cancer. Hormone therapy suddenly fell into disrepute.


Doctors became wary of prescribing the estrogen-progestin combo. Droves of hormonewomen all over the world reversed course and stopped using hormones. The withdrawal appeared to yield an immediate payoff, at least in America where medical data on this was maintained. In the 16 months following the news, breast cancer rates in the US dropped by an astonishing 14%.

Case closed? Not quite. After sifting the evidence, many scientists concluded that the long-term risks of HT are real. But they also found that the study had little relevance to women in the throes of menopause looking for short-term relief. After all, the average age of the WHI participants was 63, and most had begun using hormones more than 10 years after menopause.

These include varicose veins, history of thromboembolism, uterine fibroids, endometriosis, gall bladder disease, family history of heart disease and breast cancer.


Meanwhile, here’s a guide that will help you prepare for that talk. First, make sure you understand the known risks HT poses for some women. Then become familiar with the role hormones can play in treating menopause’s various symptoms—and learn about the alternative therapies and solutions we examine. Finally, for a quick take on whether you might be a candidate for HT, look yourself up on our chart at the end.

Your research will help you make the decision that's right for you.

Who's At Risk?


Simply stated, hormone therapy (specifically, estrogen taken with progestin) does raise the risk of breast cancer, numerous studies have concluded. The WHI findings revealed that women taking the combo had a 24% elevated risk-and the cancers detected were more advanced. But these heightened risks weren't detected during the first five years of use and not at all in women who took only estrogen.

What does this mean to you? If you've had breast cancer, estrogen with progestin is pretty much out of the question. But there are cases in which doctors do make an exception. If you've had a hysterectomy and have no other risk factors (such as heart disease), you can consider estrogen alone for hot-flash relief-even if you've had breast cancer. However, be aware that, despite the WHI findings, many researchers still believe estrogen raises the risk of breast cancer-just too slowly for them to have been detected so far.

Having no family history of breast cancer does not make hormones safer for you: Most breast cancer cases (about 80%) are diagnosed in women who are the first in their family to get it.

The WHI conclusions were stark: The combo of estrogen-progestin doubled the risk of blood clots and heightened the risk of having a heart attack by about one-quarter. Estrogen alone was not much better, increasing the risk of stroke and blood clots by about a third.

Despite this early evidence, some experts think that estrogen will turn out to help women's hearts.

One reason: They believe the WHI participants started taking hormones too late. It will be years before ongoing trials testing that theory are complete, and the issue may never be fully settled. For now, the prescription is clear: You shouldn't take hormones to protect your heart.

But does the heightened heart risk mean you can't take estrogen short-term? For most women, the answer is no: The elevated risk isn't a big issue, because at the age when most are typically considering hormones-50 or so-the baseline cardiovascular risk is generally really low.


"1.5% amount of bone loss you have per year for 1 to 5 years after menopause"

So if menopausal symptoms are torturing you, should you be scared of hormones? If you're healthy, there's a good chance you're suffering needlessly, experts say. If hormoneyou and your doctor decide your health history makes you a candidate, you'll keep risks in check by taking HT for the least time you need to (no more than 4-5 months at a stretch and not more than 5 years with breaks). If you're dead set against HT, there are effective alternatives.

If You Have Hot Flashes

HT Help: When natural estrogen levels fall off, temperature regulation goes haywire for several years-severely in one in four women. Estrogen reigns supreme for dealing with hot flashes and night sweats and the insomnia and grumpiness those results.

A completely natural antidote that one study showed cut hot flashes in half: Breathe in slowly and deeply, hold your breath for a few seconds, then exhale. Try this drill twice daily for 15 minutes and when a hot flash comes on.

Since hot flashes are often precipitated by stress, caffeine, hot drinks, cigarettes, and spicy food, keep a diary of triggers and figure out all the things you should avoid. Some prescription medications have also been proven effective at quelling hot flashes.

"51.4 average age at which natural menopause occurs; the transition lasts about 4 years"



HT Help: Dwindling levels of estrogen cause vaginal tissues to thin and dry and the vaginal canal to shrink; you'll naturally secrete less lubrication, too. Intercourse can feel uncomfortable, and the genital area may be more prone to burning, irritation, bleeding and tearing. Estrogen protects against these normal ageing changes. If you have substantial hot flashes too, it makes sense to consider hormones-two problems fixed with one pill. But you need not opt for a drug.

And here's a welcome fact: Sexual activity helps keep juices flowing and protects against vaginal shrinkage. Menopause shouldn't be a reason to stop having sex-quite the opposite.


HT Help: No question about it: Estrogen is really good at keeping bones strong and cutting the risk of fracture. But because you can take hormones for only short term HT offers only short-term protection against osteoporosis. Once off hormones, you'll rapidly lose the bone you retained. For long-term protection, choose other therapies. Bisphosphonates-effective, bone-building drugs appear safe, but their risks past 10 years of use are unknown. They're also not well tolerated by everyone-about 15 to 20% of women get heartburn from them.

But chances are, you won't need bone-building drugs, including hormones, until later. Fracture risk in your 40s and 50s is slight. Doctors often wait until you turn 60, when your bone density is more likely to drop significantly, to start drugs such as Bisphosphonates.

If you have Mood Issues & Mental Fuzziness

HT Help: You're grumpy and a little downcast. You've been short with colleagues and friends and have been losing the car keys every now and then. Is it just a coincidence that you're also peri-menopausal?

Some doctors suspect menopause can cause a decline in your sense of well-being, but most of them wouldn't advise taking hormones just to improve mood.

Bottom Line: Make every effort to avoid medication. If you have to take hormones, take the lowest dose for the shortest possible time.