Do the benefits of hormone use after menopause outweigh the risks?

The best evidence for the risks and benefits of postmenopausal hormone use comes from the Women's Health Initiative (WHI), a large randomized clinical trial of over 16,000 healthy women ages 50 through 79, in which half of the participants took hormones and the other half took a placebo pill (which does not contain any drug). The trial, sponsored by the National Institutes of Health (NIH), was halted early when, in July 2002, investigators reported that the overall risks of estrogen plus progestin, specifically Prempro™, outweighed the benefits (2). The WHI found that use of this estrogen plus progestin pill increases the risk of breast cancer, heart disease, stroke, and blood clots. The study also found that there were fewer cases of hip fractures and colon cancer among women using estrogen plus progestin than in those taking a placebo (2). 

Findings from the WHI Memory Study (WHIMS), reported in May 2003, showed that in older women, age 65 and above, use of estrogen plus progestin doubled the risk of developing dementia (3). These same women also did more poorly on cognitive function tests compared with those taking placebo (4). 

Additionally, an analysis of the quality of life of a subgroup of WHI participants ages 50 through 79 found no change in general health, vitality, mental health, depressive symptoms, or sexual satisfaction associated with use of estrogen plus progestin (5). 

The risks and benefits of estrogen alone are less clear. The study of women in the WHI taking estrogen alone is scheduled to continue until 2005, and the results of this trial will provide evidence for the associated health effects.

Questions and Answers About Menopausal Hormone Use

• What is menopause?

• What are menopausal hormones and why are they used?

• How do scientists determine the health outcomes associated with hormone use?

• Do the benefits of hormone use after menopause outweigh the risks?

• What are the effects of hormone use on the uterus?

• How does menopausal hormone use affect breast cancer risk and survival?

• How does menopausal hormone use affect the risk of ovarian cancer?

• What are the effects of menopausal hormones on heart disease?

• What are the effects of menopausal hormones on bone health?

• What are the effects of postmenopausal hormone use on quality of life and cognitive functions, specifically memory and learning?

• Are there other benefits or risks associated with menopausal hormone use?

• What are the risks of menopausal hormones for women who have a history of cancer?

• Does the route of administration of hormones make a difference?

• Are there any alternatives for women who choose not to take menopausal hormones?

• What research still needs to be done?