A new report by a panel of international experts casts doubt on longstanding claims that hormone replacement in postmenopausal women can prevent or treat a variety of ills, including heart disease, Alzheimer's disease, major depression, urinary incontinence and broken bones due to osteoporosis.
While hormone therapy is the most effective way to relieve such menopausal symptoms as hot flashes and night sweats, scientific evidence is insufficient to support its use for the other problems, says the report, to be published in June.
And the hormones have well-documented drawbacks, including increased risk of blood clots and gallbladder disease and, with prolonged use, breast cancer.
More than 40 million American women are 50 or over, and 20 million more will reach menopause in the next decade. About 20 percent of women who reach menopause naturally use hormone replacement at least temporarily, according to the North American Menopause Society. The figure is higher in women who reach menopause early because of surgery to remove their ovaries.
Hormone replacement usually consists of estrogen with another hormone, progestin, or, for women who have had hysterectomies, estrogen alone.
Given the known risks and limited benefits of hormone treatment, the report says, each woman and her doctor should weigh her medical history carefully in deciding whether she really needs it.
Drugs to lower cholesterol and blood pressure are better for reducing the risk of heart disease for many women, and other non-hormone drugs work better in preventing fractures.
That advice departs from decades of medical practice: many women and their doctors assumed that taking estrogen at menopause was a way to preserve youth and health.
The new report, called the "International Position Paper on Women's Health and Menopause," was financed by the National Institutes of Health and the Giovanni Loren Zini Medical Science Foundation of Italy.