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For years women have struggled over whether to go on hormone replacement therapy. Many women decided the answer for them was yes -- to help prevent heart disease or osteoporosis.
But at a recent NIH scientific conference on hormone therapy, University of California San Francisco's Dr. Deborah Grady said new findings mean the answer should be a resounding no.
"This is no longer a dilemma. There is no woman who is going to benefit from preventive therapy,"she says.
So if the risks of long-term hormone therapy are now thought to outweigh the benefits, what about using hormones short-term to treat symptoms of menopause?
"Hormone therapy I think is just not appropriate for women with tolerable symptoms because it has real risk of real disease outcomes," Grady says. "On the other hand, only a woman herself can judge how severe these symptoms are and how much risk she's willing to take."
Grady says overall the risks are relatively small, but use should be minimized to lessen those risks. In addition, there's no sense in taking a treatment for symptoms if the symptoms are gone -- views that are shared by breast cancer expert Dr. Susan Love.
"For women going through menopause who have symptoms that are interfering with their lives, that they feel the need to do something about, I think short-term use of hormones for three years, four years, is probably -- it's not safe, but the risk is pretty low," Love says.
Since the Women's Health Initiative looked only at one type of hormone therapy, Prempro, a combination of estrogen and progestin, would choosing a different type of hormone be a better choice? We really don't know.
"To immediately assume that another type of estrogen, like a patch, is safer or that it still comes with benefit, is where we don't have the data to say that," says Dr. Marcia Stefanick with the World Health Institute.
"So we can say it's different, and it might be something that a woman would want to take, but you can't just say it's clearly safer. We don't know that," she says.
We also don't know about estrogen taken with progestin. That part of the Women's Health Initiative is still underway. It's just one of many questions that remain unanswered.
Wyeth Pharmaceuticals, the manufacturer of Prempro, is updating its package inserts to state more prominently that the products should be used for the shortest time possible to meet the individual patient treatment goals.
