Whipsawed Again on Hormones

Hormones are bad! Hormones are good! That's an oversimplification, but certainly the conclusion you might reach if you're following the recent news on hormone replacement therapy. Today, Harvard researchers report that taking HRT can nearly halve a woman's risk of developing age-related macular degeneration, the leading cause of vision loss and blindness in those over 50. Last week, the news was less rosy: Researchers reported that taking estrogen during menopause increased the likelihood of developing benign breast disease, which is associated with a higher breast cancer risk. I blogged in February about HRT raising the risk of having a breast biopsy and wrote a feature on how women deal with the hormone dilemma when they're hit with nasty menopausal symptoms like drenching night sweats.

At this point, I'm thinking (probably along with many other women): Enough already!

How many flip-flopping findings do we need before researchers are satisfied that women have gotten the message that HRT has both risks and benefits? It's been well reported that starting hormones years after menopause causes more heart disease and strokes but that taking the drugs during the actual transition may not do any heart damage and might actually be protective. While the increased breast cancer risk is certainly real, it's considered by most experts to be pretty small.

And now this macular degeneration benefit. How should that factor into a woman's decision? I asked Harvard Medical School researcher Diane Feskanich, who led the macular degeneration study published in today's Archives of Ophthalmology. "I personally don't think it should," she says, "unless she's at high risk for macular degeneration because of a family history." So if your parent, sibling, or grandparent had macular degeneration, talk to your doctor about this new finding. And know that you don't need to stay on hormones for very long. Taking HRT for as little as three years, Feskanich says, conferred the same protective benefits as taking it for 10.

Most women can rest assured that regardless of the good-for-you-bad-for-you findings, the "bottom-line" advice dispensed at the end of most news reports is right on target: Take the lowest dose of HRT that's effective to relieve any menopausal symptoms for the shortest amount of time. Need proof? Check out yet another finding released last week that lower doses of HRT confer lower health risks.