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Should I be taking estrogen plus progesterone to prevent heart disease after menopause?

A 2004 study showed that women who take a combination of estrogen plus progesterone after menopause may have an increased risk of breast cancer, heart disease, stroke, and blood clots. These risks outweigh the benefits of the medications in most women. These findings are based on the Women’s Health Initiative (WHI) study, which evaluated the effects of estrogen plus progestin therapy on heart disease in healthy post-menopausal women.

In the WHI study, women in the study group received estrogen plus progesterone in a single combined tablet (conjugated estrogen 0.625mg and medroxyprogesterone 2.5mg as Prempro). Other estrogen products include Premarin, Cenestin, Estrace, estradiol, Ogen, and estropipate. Examples of progesterone products include Provera, medroxyprogesterone, and Cycrin.

According to an updated analysis of the breast cancer findings of the Women’s Health Initiative (WHI) Estrogen-Alone Trial, which in 2006, estrogen-alone hormone therapy does not increase the risk of breast cancer in postmenopausal women.

Over an average of about 7 years of follow-up, study participants taking estrogen had fewer breast cancer tumors than those in the placebo group. However, the new analysis also found that participants taking estrogen had 50 percent more abnormal mammograms that required follow-up and underwent 33 percent (747 compared to 549) more breast biopsies.

The WHI feels that longer follow-up is needed to explain the reduced number of breast cancers in women taking estrogen. Moreover, this new analysis does not alter the WHI's conclusion that estrogen-alone and estrogen plus progestin should only be used to treat menopausal symptoms and should be used at the smallest effective dose for the shortest possible time.”

Be sure to discuss other methods recommended for the prevention of heart disease and osteoporosis, including lifestyle changes and medicines. Also remember to have regular breast self-examinations and mammograms.

Sources:
National Institutes of Health: http://www.nhlbi.nih.gov/whi/hrtupd/index.htm, accessed 7/10/02.
NIH News, "WHI Updated Analysis: No Increased Risk of Breast Cancer with Estrogen-Alone." http://www.nih.gov/news/pr/apr2006/nhlbi-11.htm. 4/11/2006.
Women’s Health Initiative Investigators, "Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women." The Journal of the American Medical Association, 228 (2002).

This answer prepared 7/10/2002.
This information updated 1/22/2007.

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