WASHINGTON – Despite its clear risks and bad press, hormone therapy (search) remains the best treatment for some women suffering miserable menopause (search) symptoms — and it is inappropriate for doctors to withhold, says a new guide to help doctors and patients with the difficult decision.
Women who do try estrogen should use the lowest possible dose for the shortest period of time, the American College of Obstetricians and Gynecologists (search) stressed.
But about 10 percent of women will suffer these menopausal symptoms for longer than the average four years — and if hormone therapy offers them relief, it shouldn't be withdrawn, the new recommendations conclude.
ACOG issued the new guide because of continuing confusion stemming from a major 2002 study that found hormones not only didn't keep postmenopausal women generally healthy — once a top reason for using them — but they could spur heart attacks, strokes and other illnesses.
Millions have since quit hormone therapy. And those who get no menopause relief from alternative treatments often have a hard time persuading a doctor to provide estrogen, said Dr. Nanette Santoro of the Albert Einstein College of Medicine, who co-authored the ACOG guide.
"There was such a fear of hormones that they began to be viewed as poison," Santoro said. "Yet for some women, nothing works better."
So ACOG examined the 2002 research and a string of additional hormone studies performed since, to recommend how to decide which menopausal women truly are hormone candidates. Among the findings:
— Antidepressants known as SSRIs, such as Prozac, also can relieve hot flashes even in women who aren't depressed, offering a potential alternative before resorting to hormones.
— Herbal remedies such as black cohosh, wild yams or soy so far don't seem to work. Women with mild symptoms might get a short-term placebo effect, but in strict scientific studies, the herbs perform no better than dummy pills, Santoro explained.
— Contrary to popular myth, there's little evidence that estrogen, or the male hormone testosterone, improves a woman's sex drive. But, estrogen given orally or topically can improve the quality of postmenopausal sexual activity by relieving vaginal dryness that can make intercourse uncomfortable.
— Estrogen remains the most effective treatment for hot flashes and night sweats, and taking it either orally, through a skin patch or vaginally seems to work. Even it doesn't alleviate everyone's symptoms; a four-week trial may be necessary.
— On the risk side, estrogen alone — an option only for women who've had a hysterectomy — increases the risk of strokes, blood clots and possibly dementia. Combination hormone therapy — estrogen plus progestin — raises the risk of heart attacks, strokes, blood clots and breast cancer.
Some women have additional risk factors for those conditions that hormones could exacerbate, such as high blood pressure or cancer in the family. And while many doctors consider long-term use the biggest problem, the risk of blood clots or clot-caused heart attacks actually starts rising immediately.
So whether to take hormones requires a case-by-case judgment of how bad the woman's hot flashes are weighed against her individual risk of side effects, the guide says. Hormone users should review that decision annually with their doctors — they may have become more prone to side effects, or the symptoms eased enough to quit.
That's similar to advice from the Food and Drug Administration (search) and other medical authorities.
But the gynecologist group goes a step further to stress that "it is inappropriate" to withhold hormones from appropriate candidates.
The doctors' guide was published Thursday in the journal Obstetrics & Gynecology. Starting Monday, women can go to http://www.acog.org for a consumer version.