Seek assessment for disruptive menopausal hot flushes and night sweats; do not self-start hormones or use them to prevent chronic disease

Cost: Attend a gynaecology or menopause clinic. A clinician reviews history, suitability and follow-up before prescribing. The source cautions both against assuming every hormone exposure causes cancer and against buying hormones for supposed anti-ageing effects.

In plain language: Oral hormone therapy reduced hot-flush frequency compared with placebo in the cited trials. Risks depend on population and regimen. The source reports increased breast cancer, thrombosis and stroke with the studied combined regimen, while long-term overall mortality did not clearly change. It does not support using hormones to prevent heart disease or dementia.

Symptom findings reported by the source: A Cochrane review included 24 randomized trials and 3,329 participants comparing oral hormones with placebo. Hot-flush frequency was around 75% lower relative to placebo (95% CI 64.3–82.3), and severity also decreased (OR 0.13, 95% CI 0.07–0.23). Placebo recipients themselves improved by around 57.7%, emphasizing the importance of a placebo comparison.

WHI findings reported by the source: In 16,608 women with a uterus aged 50–79, estrogen plus progestin over a mean 5.2 years had HRs of 1.29 (95% CI 1.02–1.63) for coronary heart disease, 1.26 (1.00–1.59) for invasive breast cancer, 1.41 (1.07–1.85) for stroke and 2.13 (1.39–3.25) for pulmonary embolism. Per 10,000 women annually, this corresponded to seven additional coronary events, eight strokes, eight pulmonary emboli and eight invasive breast cancers, alongside six fewer colorectal cancers and five fewer hip fractures. In women with hysterectomy receiving estrogen alone, cumulative 13-year follow-up reported breast-cancer HR 0.79 (0.65–0.97).

Longer-term and subgroup findings reported by the source: Combining two trials over 18 years gave overall-mortality HR 0.99 (95% CI 0.94–1.03). During treatment, starting-age subgroups had HR 0.69 (0.51–0.94) for ages 50–59, 1.04 (0.87–1.25) for 60–69 and 1.13 (0.94–1.36) for 70–79. At 18 years, the 50–59 subgroup HR was 0.89 (0.79–1.01), no longer statistically clear. The source describes the 2017 Cochrane younger-age analysis as identifying increased thrombosis with combined therapy, with absolute risk under 1/500. In women older than 65 using combined therapy, four-year dementia estimates increased from nine per thousand to 11–30 per thousand. The 2022 USPSTF recommendation opposes hormone therapy for primary prevention of chronic conditions because it finds no net benefit.

Source author's evidence grade: A; not site verification or professional approval.

Notes and dispute: WHI's average age was 63 and it tested a fixed oral regimen, differing from many symptomatic people starting near menopause. An age-subgroup mortality finding does not establish that hormones extend life, especially as it was no longer statistically clear at 18 years. Cochrane describes insufficient trial size to resolve risks within ten years of menopause. A clinician assesses prior breast cancer, thrombosis, cardiovascular risk, obesity and other suitability factors. Estrogen alone in someone with a uterus increases endometrial-cancer risk, so the source describes adding progestogen; estrogen alone is considered after hysterectomy. Fracture reduction is a separate consideration, generally when other osteoporosis medicines are unsuitable in this account; see chapter 1, entries 39 and 40. The source's large-benefit label refers to symptom reduction, not overall mortality, and considers the reader, their mother or partner.

Original source bibliography (titles retained as supplied): 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；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；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；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；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；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