Finding a balance: Confusion over hormone replacement therapy leaves many women hot

After a decade of rancorous debate over the risks and benefits of menopausal hormone therapy, experts from more than a dozen top medical organizations worldwide have finally come to something resembling a consensus. What did they decide, and why are women still baffled?

What is menopausal hormone therapy?

Also called hormone replacement therapy, its a treatment for women in the throes of menopause, the inevitable period of life when estrogen naturally declines. Taking estrogen or a combination of estrogen and another hormone, progestin, the synthetic form of progesterone, can alleviate some of the symptoms of menopause, including hot flashes, night sweats, insomnia and vaginal dryness, said Atlanta endocrinologist Scott Isaacs. Women typically hit menopause around age 51.

Why is hormone therapy controversial?

It has been under intense scrutiny since 2002, when a large study called the Womens Health Initiative reported that taking additional hormones specifically the combination of estrogen and progestin increased risk of blood clots, stroke, breast cancer, heart attacks and gall bladder disease for some women. For a woman with a uterus, estrogen treatment alone raises her odds of getting endometrial cancer. Researchers abruptly halted the study, concluding that risks outweighed benefits. Almost overnight, millions of women abandoned hormone therapy.

What have we learned over the last 10 years?

Hormone therapy still has an important role in treating women who have symptoms, but it shouldnt be used to prevent disease. Its best to take the lowest possible dose for the shortest amount of time.

For symptom relief, if youre healthy and in your 50s, and it has been less than 10 years since menopause, its pretty much a green light, said Dr. Cynthia Stuenkel, a clinical professor of medicine at the University of California at San Diego. Hormone therapy is also beneficial for bone health and may decrease mortality and cardiovascular disease.

But its not right for everyone; the risk level depends on a womans age, health history and the number of years since her menopause began, says The Endocrine Society.

What is still up for debate?

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Finding a balance: Confusion over hormone replacement therapy leaves many women hot