Menopause hormone replacement therapy may not cut risk

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Researchers say some menopause treatments aren’t highly effective in reducing the risk of some diseases. SolStock/Getty Images
  • In a new study, researchers say they can no longer support using hormone replacement therapy as a preventive measure for cardiovascular disease. However, they say it can help reduce vasomotor symptoms such as hot flashes.
  • They also said they can no longer support calcium and vitamin D supplementation, sometimes used to prevent fractures, as a preventive therapy.
  • The researchers did say that low-fat diets done over a long term might help reduce the risk of breast cancer mortality.

Hormone replacement therapy to prevent cardiovascular disease, a low-fat diet to prevent breast cancer or colorectal cancer, and calcium with vitamin D supplementation for fractures in postmenopausal women have been used as preventive treatments.

However, in a new study from the Women’s Health Initiative published in the journal JAMA, researchers looked at these treatments and concluded they can no longer support these therapies as preventive measures for certain diseases.

Clinical trials from the Women’s Health Initiative examined the health effects of several treatments for postmenopausal women:

  • Hormone (estrogen) therapy to prevent cardiovascular and other chronic diseases
  • Calcium and vitamin D supplements to reduce fractures
  • A low-fat diet with increased fruits, vegetables, and grains to prevent breast or colorectal cancer

The studies included 161,808 women ages 50 to 79, with up to 20 years follow-up periods. The researchers noted that 55 million women in the United States and 1.1 billion worldwide are postmenopausal, and many have used at least one of these therapies to help improve their health.

Participants in the study received oral hormone treatment.

The researchers compared the cardiovascular health of those who received hormone treatment with those who received a placebo.

They said their findings did not support using hormone therapy to prevent cardiovascular or heart disease, stroke, dementia, or other chronic diseases. They added that the therapy significantly increased the incidence of breast cancer.

The scientists did find that this treatment helped reduce vasomotor symptoms in women in early menopause. Vasomotor symptoms include hot flashes, night sweats, heart palpitations, and changes in blood pressure.

“Data on hormone therapy and calcium supplementation over the years has been a roller coaster,” said Dr. Nicole Weinberg, a cardiologist at Providence Saint John’s Health Center in California who was not involved in the research. “One study shows it works and another shows it doesn’t. I like this study because it is a conglomeration of data that has been accumulating for years.”

“I think the data is pretty conclusive that hormone therapy should be used symptomatically, for example, for vasomotor symptoms,” Weinberg told Medical News Today. “But it is clear it does not prevent cardiovascular disease. In the postmenopausal years, women’s bodies become more chemically aligned with men and, therefore, I am going to treat symptoms accordingly. If someone has high blood pressure, I will treat that. If someone has high cholesterol, I will treat that.”

“Overall, I think this is a great study and provides very helpful information for treating women in the different stages of menopause,” Weinberg added.

Research from the 1980s and 1990s found a decreased risk of heart disease in women who took hormone therapy, according to Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California who was not involved in the study.

More recent ones, Chen explained, did not find the same results, however.

“Because of this, we have recommended against the use of hormone replacement therapy for heart disease prevention for quite some time now,” Chen told Medical News Today.

“Our recommendations for cardiovascular risk reduction in postmenopausal women are essentially the same as those for the general public: eat a heart-healthy diet, get plenty of exercise, maintain a healthy weight, avoid tobacco and alcohol, get good sleep, and watch your blood pressure, blood sugar, and cholesterol levels,” Chen added.

“[The use of] estrogen plus progesterone therapy in postmenopausal women, this combination appeared to significantly increase the risk of developing stroke or pulmonary embolism,” Chen noted.

The women in the new study received 1,000 milligrams per day of calcium and 400 IU/d of vitamin D daily.

The researchers assessed the participants for hip fractures and reported that supplementation did not prevent these injuries in postmenopausal women. The researchers noted that women not meeting the national dietary guidelines might benefit from taking supplements.

According to the NIH Office of Dietary Supplements, the recommended daily allowance for calcium and vitamin D is 1,200 mg/day and 600 IU/day, respectively, for women aged 51 to 70.

Additional research published in March 2024 found that calcium and vitamin D supplementation in postmenopausal women might reduce the risk of death due to cancer but could potentially increase the risk of death from cardiovascular disease.

The participants in this new study followed a diet that reduced their fat intake by about 20%. They also increased their fruit and vegetable intake to at least five servings per day and their grain intake at least six servings daily.

The researchers assessed these women for incidence of breast or colorectal cancer.

They reported that the low-fat diet did not significantly decrease the incidence of either of these cancers. However, a long-term follow-up did note a reduction in breast cancer mortality.

The scientists did indicate the diet may be an option for postmenopausal women who wanted to reduce their risk of death due to breast cancer.

“Perimenopause marks a period of transition and transformation for women, characterized by hormonal fluctuations affecting various parts of the body, including the brain,” Dr Adi Katz, the director of gynecology at Northwell Lenox Hill Hospital in New York who was not involved in the research, told Medical News Today. “Research has linked these hormonal changes to conditions like PCOS [polycystic ovary syndrome], PMDD [premenstrual dysphoric disorder], and PMS [premenstrual syndrome], which may heighten the risk of anxiety and depression. It’s crucial to destigmatize these experiences and offer support to women during this significant life phase.”

The researchers noted several limitations to their study:

  • They used the most common hormone therapy treatment in the study. However, there may be additional formulations that could provide different or better results.
  • Non-study calcium and vitamin D supplements could have affected the results.
  • The low-fat diet did not achieve the target of 20% of total calories and the scientists could not distinguish the effects of reducing fat from the impact of increasing fruits, vegetables, and grains.
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