Researchers say some menopause treatments aren’t highly effective in reducing the risk of some diseases.
- 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.
Details from
the study on hormone replacement therapy
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.
Calcium and
vitamin D supplementation
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.
Low-fat
diets and cancer prevention
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.”
Limitations
of the menopause treatment study
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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