If hot flashes and night sweats around menopause are affecting your life, see a gynecologist about hormone therapy; don't just put up with it, don't buy the drugs yourself, and don't use it to prevent heart disease

Cost

One visit to a gynecology or menopause clinic. The doctor will take your history, check whether you have any condition that makes hormones unsuitable, and prescribe if appropriate. Once you are on it, you follow up as the doctor requires. The hard part is putting down the fear that hormones give you cancer at a touch, and also not buying them yourself because you heard they fight aging.

What you get

Cochrane pooled 24 randomized trials with 3329 people, comparing oral hormones with a placebo. People on hormones had about 75% fewer hot flashes a week than on placebo (95% CI 64.3–82.3, the plausible range). The severity of hot flashes was also clearly milder (OR 0.13, 0.07–0.23). People on placebo also had about 57.7% fewer hot flashes, which is why anything said to treat hot flashes only counts if it has been compared against a placebo. For risks, look at the U.S. WHI (Women's Health Initiative) randomized trial. 16608 women aged 50 to 79 who had a uterus took estrogen plus progestin and were followed for an average of 5.2 years. Coronary heart disease was about 29% higher (HR 1.29, 1.02–1.63). Invasive breast cancer was about 26% higher (HR 1.26, 1.00–1.59). Stroke was about 41% higher (HR 1.41, 1.07–1.85). Pulmonary embolism was about 2.13 times (HR 2.13, 1.39–3.25). In absolute numbers, per 10,000 (1万) women per year there were 7 more cases of coronary heart disease, 8 more of stroke, 8 more of pulmonary embolism and 8 more of invasive breast cancer. At the same time there were 6 fewer cases of colorectal cancer and 5 fewer hip fractures. Among women who had had their uterus removed and took estrogen alone, over a cumulative 13 years of follow-up, breast cancer was actually about 21% lower (HR 0.79, 0.65–0.97). Following the two trials together for 18 years, overall mortality did not change (HR 0.99, 0.94–1.03). By age at starting, the 50-to-59 group had about 31% lower overall mortality during the years of treatment (HR 0.69, 0.51–0.94). For ages 60 to 69 it was 1.04 (0.87–1.25), and for 70 to 79 it was 1.13 (0.94–1.36), neither significant. Followed to 18 years, the 50-to-59 group was 0.89 (0.79–1.01), no longer significant either. The 2017 Cochrane review, looking only at women aged 50 to 59, found the only clear increase was blood clots with combined estrogen-progestin, with an absolute risk under 1/500. For women over 65 on combined estrogen-progestin, dementia over 4 years rose from 9 cases per 1000 people to 11 to 30 cases. In 2022 the U.S. Preventive Services Task Force recommended against using hormones to prevent chronic disease (grade D) and concluded there is no net benefit.

Notes

Disputed: the WHI women averaged 63 years old and used a fixed oral regimen. Most people today use hormones at around 50, just after menopause, for symptoms, which is not quite the same as the people in the trial. The lower mortality in the 50-to-59 group was seen by looking at age groups, and was not significant by 18 years of follow-up, so you cannot say hormones extend life. Cochrane also states that the trials were not large enough to see clearly the risks for women within 10 years of menopause. The following kinds of people are generally not suited: those who have had breast cancer, those who have had blood clots, those at high cardiovascular risk, and very obese women; the doctor decides the specifics. For women with a uterus, estrogen alone increases endometrial cancer, so progestin has to be used at the same time; only women who have had the uterus removed can use estrogen alone. Hormones can also reduce fractures, but are generally considered only when other anti-osteoporosis drugs are unsuitable. For osteoporosis, first see §1.39 (bone density test) and §1.40 (if osteoporosis is found, take medicine). The size of the benefit is rated large based on about 75% fewer hot flashes, and the end point is symptoms, not overall mortality. The person who benefits from this item is mainly you, and also your mother and spouse.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. MacLennan AH, Broadbent JL, Lester S, Moore V (2004). Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database of Systematic Reviews, (4), CD002978. https://doi.org/10.1002/14651858.CD002978.pub2
2. Writing Group for the Women's Health Initiative Investigators, Rossouw JE, Anderson GL, Prentice RL, 等 (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3), 321-333. https://doi.org/10.1001/jama.288.3.321
3. Manson JE, Chlebowski RT, Stefanick ML, 等 (2013). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA, 310(13), 1353-1368. https://doi.org/10.1001/jama.2013.278040
4. Manson JE, Aragaki AK, Rossouw JE, 等 (2017). Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women's Health Initiative randomized trials. JAMA, 318(10), 927-938. https://doi.org/10.1001/jama.2017.11217
5. Marjoribanks J, Farquhar C, Roberts H, 等 (2017). Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews, (1), CD004143. https://doi.org/10.1002/14651858.CD004143.pub5
6. US Preventive Services Task Force, Mangione CM, Barry MJ, 等 (2022). Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons: US Preventive Services Task Force recommendation statement. JAMA, 328(17), 1740-1746. https://doi.org/10.1001/jama.2022.18625

Translated from the Chinese original. Original book, section 2, tip 43. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer