Deciding whether to use hormone replacement therapy (HRT) after menopause is a difficult decision many women face as they age. Research has shown that HRT is very effective for relieving menopausal symptoms such as hot flashes and vaginal dryness. It also can reduce the risk of osteoporosis. However, there are also known health risks and uncertainties about long-term use. Recent research has demonstrated that long-term use of estrogen in combination with progestin results in more risks than benefits.
On July 9, 2002, the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health announced that they would stop a major clinical study of the type of postmenopausal hormone therapy in which estrogen is combined with progestin. The study, a part of the Women's Health Initiative, found increases in breast cancer, cardiovascular disease, stroke and blood clots in study participants who were taking estrogen plus progestin compared to women taking placebo pills. There were noteworthy benefits of estrogen plus progestin, including fewer cases of hip fractures and colon cancer, but on balance the harm was greater than the benefit.
Many women may now be considering using alternatives to conventional HRT to relieve menopausal symptoms and to lower the risk of conditions such as osteoporosis and heart disease. According to a 1997 study conducted by the North American Menopause Society, more than 30 percent of women use acupuncture, natural estrogen(s), herbal supplements or so-called plant estrogens (phytoestrogens). At this time, there is not enough scientific evidence to determine whether these therapies are beneficial. In addition, we do not have sufficient information to show whether these therapies are as safe or safer than conventional drugs being used for menopausal symptoms, osteoporosis or heart disease.
Botanical products containing or acting like estrogens may provide some of the benefits of estrogen in relieving menopausal symptoms. For example, studies have suggested that soy food products can benefit women with mild hot flashes. Some limited research provides conflicting results on the safety and effectiveness of herbal products — such as ginseng, black cohosh and dong quai — that are marketed for menopausal symptoms. Currently, the National Center for Complementary and Alternative Medicine is funding research on several botanicals that have shown promise for reducing menopausal symptoms including black cohosh, red clover, hops, dong quai, flax seed and dietary soy.
Through this research, researchers are hoping to learn more about the mechanism of action as well as the safety and effectiveness of these botanical products. Studies are needed to define the possible benefits of these botanical products in promoting bone, heart and brain health, as well as the potential risks of increasing breast, endometrial or other cancers in diverse populations of postmenopausal women.
Advice to Consumers
Postmenopausal women should consult their health care provider about their personal risks and benefits of using HRT, as well as the use of alternative therapies. Certain lifestyle changes including quitting smoking, eating well, and exercising regularly can also offer benefits and should be considered for promoting healthy aging and reducing the risk of heart disease.
Alternative therapies may or may not be helpful in relieving menopausal symptoms. More research is needed to define the benefits and risks.
Herbal therapies may have adverse side effects or exhibit harmful interactions with other medications. Consumers should always discuss their use of herbs and dietary supplements with their health care provider
The cost of alternative therapies, such as dietary supplements, is usually not covered by insurance.
This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.
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