In the last few years, we've heard so many seemingly contradictory messages about whether or not it's safe to use menopausal hormone therapy. While the debate continues, many doctors are concerned that women who might benefit from taking hormones are unnecessarily scared off.
That's the point of a recent consensus statement from the North American Menopause Society, a group that many doctors belong to. The statement makes a clear distinction between two types of hormone therapy, and it is that distinction that accounts of some of the confusion among the general public.
Women who no longer have uteruses and ovaries take only estrogen while women who still have their uteruses must take a combination of estrogen and a progestin to prevent precancerous cells from building up in the lining of the uterus.
Estrogen-only therapy may provide clear benefits to specific groups of women, especially those who lose their ovaries years before the average age of menopause in the industrialized world, which is 51. (You've reached menopause when you've gone 12 months without a menstruating.)
The new statement says that these women can use estrogen-only therapy for seven years without increasing their risk of breast cancer. Women who use estrogen and progestin therapy — because they still have a uterus — increase their risk of breast cancer after three years of hormone therapy.
The statement also addresses differences in the risk of heart disease after taking menopausal hormone therapy.
Women in their 50s who take estrogen alone because they no longer have a uterus may experience a slight decrease in their risk of heart disease, the statement says. The data is less clear on heart disease risk for women who use the combination therapy because they still have their uterus.
The timing of the therapy makes a difference as well. The statement says that both forms of hormone therapy appear to increase heart disease risk if started more than 10 years after menopause.
The statement contains other guidance for dealing with specific symptoms such as hot flashes and vaginal dryness. If you're considering hormone therapy, ask your doctor whether the new guidance should affect your decision.
The one thing everyone agrees on is that there is no one-size-fits-all answer to the question of whether you should take hormone therapy at menopause. Each woman and her doctor must assess her individual risks and benefits.