I’ll give you the headline first: Estrogen and progestogen therapy started soon after menopause not only relieve symptoms, but appear safe.
The Kronos Early Estrogen Prevention Study (KEEPS) was a four-year, randomized, double-blinded, placebo-controlled clinical trial (in other words: reliable, scientific, and unbiased) of low-dose oral or transdermal estrogen and progesterone in 727 healthy women ages 42 to 58 who were within three years of the onset of menopause.
There were three groups:
- Group 1 received oral estrogen (given as Premarin, 0.45 mg/day -- a lower dose than the 0.625 mg/day used in the WHI).
- Group 2 received a transdermal estradiol (given by Climara patch, 50 µg/day (µg = microgram)).
- Group 3 received a placebo (no hormone).
In women who used either oral or transdermal estrogen, there was excellent relief of symptoms. There was no increase in blood pressure, no effects on atherosclerosis, no increase in breast cancer or uterine cancer, or blood clots associated with stroke and myocardial infarction.
Oral estrogen was associated with an increase in HDL (“good”) cholesterol along with a decrease in LDL (“bad”) cholesterol. However, there was an increase in triglyceride levels.
Transdermal estrogen did not affect cholesterol or triglycerides, and lowered insulin resistance.
The bottom line is it appears to be safe for most newly menopausal women to use hormone therapy. While both oral and transdermal estrogen have minimal risks, there appear to be advantages of transdermal estrogen therapy, particularly if a women is diabetic or at risk for cardiovascular disease.
How long can a woman safely continue hormone therapy? No one really knows, but as the study continues, that question will be answered as well.
So, there you have it. The KEEPS study researchers emphasize that hormone therapy must be individualized depending on symptoms, priorities, and risk factors. Estrogen isn’t poison, and, for the most part, miserable menopausal women can be flash-free and no longer need to feel like they are risking their lives in the name of a good night of sleep.
More Answers from Lauren Streicher, MD