Hormone Replacement Therapy in Newly Menopausal Women May Carry More Benefit
Hormone replacement therapy for newly menopausal women may not be as risky as once believed, according to the results of a study presented at the 23rd annual meeting of the North American Menopause Society in Orlando, Florida in October 2012. In fact, the researchers concluded that combination hormone replacement therapy in newly menopausal women relieves symptoms and improves mood, bone density, and several markers of cardiovascular risk.
Hormone replacement therapy (HRT) is often prescribed for women during menopause, which is a natural phase of the female lifecycle during which the ovaries produce significantly less estrogen, ovulation ceases, and menstruation ends. For many women, menopause has uncomfortable side effects such as hot flashes, sleep disturbances, depression, mood swings, and anxiety. Additionally, menopause may also be accompanied by increased urinary tract infections, incontinence, vaginal discomfort due to a lack of estrogen-based lubrication, and decreased bone density.
Although HRT has been widely prescribed for menopausal women, it has come under scrutiny as a result of the Women’s Health Initiative (WHI) Study, which indicated that it could be linked to increased incidence of certain types of cancer and other health problems. Combined HRT has been linked with an increased risk of breast cancer, lung cancer, heart disease, stroke, and blood clots, but a decreased risk of colorectal cancer and fractures. Researchers continue to evaluate single-agent HRT and combined HRT to determine the risks and benefits of its use.
The Kronos Early Estrogen Prevention Study (KEEPS) trial was a multi-center, randomized study that included 727 healthy women ages 42 to 58, all within three years of onset of menopause at baseline. The study differs from many previous studies on HRT, including the WHI, because the participants were younger—the mean age was 52, compared to 60s for the other trials.
Women in the KEEPS trial were randomly assigned to one of three groups: placebo, progesterone plus oral estrogen, progesterone plus an estrogen patch. Both intervention groups experienced a reduction in menopausal symptoms, including hot flashes and night sweats, as well as improved sexual function and improved bone mineral density compared to the placebo group. What’s more—the results indicated that oral estrogen plus progesterone improved lipid levels and the estrogen patch improved insulin sensitivity. Neither combination raised blood pressure or altered the progression of atherosclerosis (hardening of the arteries).
The data is in sharp contrast with the WHI and other studies that raised the alarm flags regarding the use of HRT. The results of one study cannot provide enough information to make an informed decision regarding HRT use; however, they can add to the existing information so that women can make informed decisions.
The WHI was a large and comprehensive study that included 16,000 women and suggested that HRT was linked with increased blood pressure and higher risks of breast cancer, dementia, and stroke. However, some critics have speculated that the effects were magnified because the study included older women (in their 60s and 70s) who took HRT for long periods of time. In contrast, the KEEPS trial evaluated younger women who took HRT for shorter periods of time.
The jury is still out on HRT and the controversy will likely continue as ongoing research attempts to evaluate the safety of the treatment. In the meantime, the results of this particular study suggest that newly menopausal women may benefit from short-term use of HRT—in fact, it might ease menopausal symptoms and improve cholesterol and metabolic function.
Women considering the use of HRT should discuss the risks and benefits with their physician.
 Manson JE, et al. New findings from the Kronos early estrogen prevention study (KEEPS) Randomized trial. Presented at the 23rd Annual Meeting of the
North American Menopause Society, Orlando, Florida, October 3-6, 2012.
 Nelson HD, Walker M, Zakher B, Mitchell J. Menopausal hormone therapy for the primary prevention of chronic conditions: A systematic review to update the U.S. Preventive Services Task Force Recommendations. Annals of Internal Medicine. 2012; 157(2): 104-113.
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