Menopause and Balance: HRT confusion has kept many hot and bothered

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?

Hormone therapy 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 the 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 chance of getting endometrial cancer. The 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, according to The Endocrine Society.

Whats still up for debate?

Whether hormone therapy has a preventive role, Stuenkel said. Theres some evidence that estrogen therapy can effectively reduce heart disease, but its not universally agreed on, she said. Estrogen has a positive effect on bones and can help with treating osteoporosis, but its not a first-line treatment, Isaacs added. Swiss researchers recently showed that boosting estrogen might enhance muscle strength in post-menopausal women. Still, last year the U.S. Preventive Services Task Force recommended against using hormonal therapy to prevent chronic conditions. Until more is known, use hormones if you have symptoms, Stuenkel said. If you dont, make some lifestyle changes to help prevent heart disease and other aging-related issues.

Move more, try the Mediterranean diet, stop smoking. Eat, drink and be merry with a friend, she suggested.

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Menopause and Balance: HRT confusion has kept many hot and bothered