Menopausal hormone therapy is neither always dangerous nor always safe. The balance of benefit and risk changes with a woman's age, the time since menopause and her medical history.
When symptoms such as hot flushes, poor sleep and vaginal dryness make daily life difficult, the benefit of replacing hormones often outweighs the concern about side effects.
This article explains when treatment is actively recommended, when more caution is needed, and the common misunderstandings about breast cancer risk.
Can menopausal hormone therapy be recommended to every woman in the same way?
Menopausal symptoms begin with a shortage of female hormones, so treatment that replaces the missing hormones tends to work clearly. The Korean Society of Menopause has published evidence showing improvement in hot flushes, sleep problems and vaginal dryness, and the more severe the symptoms, the more a woman's quality of life often changes.
However, the timing of menopause, age, other conditions, and the level of risk for high cholesterol or osteoporosis differ completely from one person to the next. No medicine is entirely free of risk, so the right candidate, the right timing, and the right ingredients and dose need to be matched carefully to reduce risk and make the most of the benefit.
- Age — the balance between benefit and safety is known to be most favourable under 60
- Time since menopause — within 10 years of menopause the blood vessels are still healthy, so hormone replacement offers greater benefit
- Medical history — treatment can be actively recommended only when there is no contraindicated history such as thrombosis or breast cancer
Does taking hormones greatly increase the risk of breast cancer?
The concern linking hormone therapy with breast cancer came from the results of the American WHI study. Later reanalyses that accounted for factors such as age and the type of medication showed that the risk was not as large as first reported, and the figures from that time cannot simply be applied to treatment today.
A study of long-term safety enrolled postmenopausal women aged 50 to 79, gave them hormone therapy for 5 to 7 years and analysed the outcome. It concluded that the treatment was not associated with a long-term risk of death from cancer or cardiovascular disease, which points in a different direction from the common belief that hormones should always be avoided.
Is treatment ruled out if menopause was long ago or you are older?
Oestrogen helps suppress inflammation inside the blood vessels and protects them, but this effect holds only when the vessels are still healthy. If more than 10 years have passed since menopause, it is likely that vascular ageing has already progressed considerably.
Starting hormones late, when the vessels have already aged, can make them less stable and raise the risk of conditions such as blood clots, cardiovascular disease and stroke. Before treatment begins, other conditions and the severity of symptoms must be checked carefully.
- Vascular ageing — when menopause was long ago, the vessels have aged and hormone treatment can become a burden
- Clot risk — adding hormones to unstable vessels can raise the risk of blood clots
- Heart and brain risk — the possibility of stroke or cardiovascular disease needs to be considered in the decision
