Q. Are there any definite rules at this point for who should and shouldn't use hormone therapy?

A. Hormone therapy is not a 'one-size-fits-all' solution. It is important for women and their health care providers to determine whether hormone therapy is an appropriate treatment option. This decision should be based on a woman's menopausal symptoms and her medical history.

There is, however, one very clear rule at this point: Hormone therapy should not be started or continued for the express purpose of preventing cardiovascular disease, a common clinical practice in the past.

Based on the research to date, there is no apparent benefit to hormone therapy for cardiovascular disease, and there is even an increased risk for stroke with either estrogen alone or with estrogen and progestin. Generally, beginning hormone therapy at age 60, 70 or even later is not advisable. And, women at high risk for cardiovascular disease should also avoid it. Hormone therapy still has a role in the short-term treatment of menopausal symptoms, but the lowest effective dose should be used for the shortest duration necessary.

Q. I know that hormone therapy has often been prescribed to prevent osteoporosis. How does it compare with other osteoporosis medications?

A. So far, results from the Women's Health Initiative find that estrogen, either alone or with progestin, helps decrease the risk of hip fracture and other osteoporotic fractures in women. As more women stop taking hormone therapy, however, they are looking for alternatives to protect their bones. Today, several medications are available for the prevention or treatment of osteoporosis, such as Evista (raloxifene), a selective estrogen receptor modulator, or SERM, which is protective against vertebral fractures. However, studies find that estrogen, either alone or combined with progestin, is about twice as powerful in preventing osteoporosis as Evista. Bisphosphonates, a class of drugs including Fosamax (alendronate) and Actonel (risedronate) that is used in the treatment of osteoporosis, are at least as effective as hormone therapy for this purpose.

Q. When are hot flashes at their worst?

A. Generally, hot flashes are at their worst within the first two years of menopause. They gradually taper off after menopause in most women. A small percentage of women will have long-term, severe hot flashes that can be controlled with only hormone therapy. The wide variety of options now available can help relieve discomfort and minimize the negative impact hot flashes can have on women's lives, such as disrupting sleep.X

-JoAnn E. Manson, MD, DrPH
Elizabeth F. Brigham Professor of
Women's Health,Harvard Medical School,
Chief of Preventive Medicine at
Brigham and Women's Hospital
Boston, MA
A principal investigator of the Women's Health Initiative