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It's no wonder that women going through menopause may be confused about the benefits and the safety of taking hormones because the medical community is divided on that issue. NPR's Patti Neighmond tries to sort out what we now know.
PATTI NEIGHMOND, BYLINE: Over the past decades, points of view over the safety of hormone therapy have bounced back and forth. Two decades ago, most menopausal women took hormones, not just to treat hot flashes but also to prevent chronic disease. Then a huge study found the opposite - that hormone therapy actually increased a woman's risk of breast cancer and heart disease. That was in 2002. Dr. Wolf Utian, who directs the North American Menopause Society, says those findings set off a wave of panic.
WOLF UTIAN: And millions of women across the world - millions in the states, in fact, almost, in some areas, up to 80 percent of women - abruptly stopped taking their hormones.
NEIGHMOND: An overreaction, he says, particularly in light of more recent findings that show that while older women may be at risk, younger women might see some benefit when it comes to heart disease. Epidemiologist JoAnn Manson, one of the study's lead investigators.
JOANN MANSON: Women who take hormones earlier after the onset of menopause may have a favorable effect on the development of plaque, of blood vessel blockage, reduced atherosclerosis and possibly even a reduced risk of heart attack.
NEIGHMOND: So if you start taking hormones between the ages of 50 and 59, you may not only be controlling menopausal symptoms, you may also be helping your heart. But for women over 60, the benefit disappears. Manson says that's probably because older women already have plaque buildup. Researchers in Denmark also found that age makes a difference. Dr. Utian.
UTIAN: Menopausal women are young in the scale of things today. I mean, menopause occurs about halfway through life. So they're 45 to 60, and if they're going to start hormones within a few years of menopause or even sometimes just before, there are a lot of other benefits apart from the hot flashes that they will get by taking hormones. So, in my opinion, the best recommendation would be some sort of hormone therapy.
NEIGHMOND: Those other benefits include reduced risk of bone fractures, reduced risk of diabetes and, for many women, an overall boost in their quality of life - better sleep, maintenance of libido and more comfortable sex. But here's the worry - and it's not nothing - studies confirm an increased risk of breast cancer among women taking hormones regardless of age. And that scared lots of women, including Linnea Duvall, a family therapist who lives in Santa Monica, Calif. Symptoms of menopause crept up on her when she turned 50. She felt more irritable, a smidge heavier and started waking up two, three times a night. It wasn't that bad, but then a few years later, she had a hot flash.
LINNEA DUVALL: I thought - that feels like someone put a nuclear bomb off right behind my belly button and the radiation went out to my fingertips, my toes, the top of my head, to the ends of my hair.
NEIGHMOND: But hormone therapy to control the flashes - Duvall says no. She was terrified.
DUVALL: I can say it in two words - breast cancer.
NEIGHMOND: Duvall is right to be worried. There is an increased risk of breast cancer, but researcher JoAnn Manson says it's small.
MANSON: For every 1,000 women per year not using hormone therapy, about three of them would develop breast cancer. While every 1,000 women per year using hormone therapy, about four of them would develop breast cancer. So that's about one extra case of breast cancer per 1,000 women per year using hormone therapy.
NEIGHMOND: And this is where things get tricky. There is no consensus in the medical community. Different doctors interpret risk differently. If you are a breast oncologist, like Dr. Rowan Chlebowski at Harbor-UCLA Medical Center, any risk is too much.
ROWAN CHLEBOWSKI: For me, it's a disease that I see every day, so I think that's something to be avoided.
NEIGHMOND: Chlebowski questions why anyone would do anything to increase risk, even if it's small. And he says diagnosing cancer can be problematic because hormone therapy makes breast tissue more dense.
CHLEBOWSKI: The mammograms are harder to read when there's more glandular tissue. You know, that breast density is associated with difficulty in diagnosis.
NEIGHMOND: And the later cancer's diagnosed, the more difficult it is to treat. So it really is an individual decision based on how much risk a woman can tolerate in favor of symptom control and other potential benefits. Researcher Manson says if a woman chooses hormone therapy, the lowest dose possible for the shortest amount of time is safe for most women. Patti Neighmond, NPR News.
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