Low-dose estrogen can be taken orally, but it’s also now available in patches, gels and creams.

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Low-dose estrogen can be taken orally, but it’s also now available in patches, gels and creams.

svetikd/Getty Images

The benefits of hormone therapy for the treatment of menopause symptoms outweigh the risks. That’s the conclusion of a new study published in the medical journal JAMA.

“Among women below the age of 60, we found hormone therapy has low risk of adverse events and [is] safe for treating bothersome hot flashes, night sweats and other menopausal symptoms, ” says study author Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital. This is a departure from the advice many women have been given in the past.

The new analysis is based on two decades of follow-up data from the Women’s Health Initiative study, which followed thousands of women taking hormone replacement therapy. The study was halted after it was found that women taking Prempro, which is a combination of estrogen and progestin, had higher risks of breast cancer and stroke.

“The findings were surprising,” Manson says, pointing out that the reason the randomized trial was conducted was because scientists were trying to determine if hormone therapy decreased the risk of heart disease and other conditions.

After the initial findings came out, many women abruptly stopped the therapy. Prescriptions plummeted, and many healthcare providers still hesitate to recommend hormone therapy. But menopause experts say it’s time to reconsider hormone therapy, because there’s a lot known now that wasn’t known two decades ago.

Most significantly, there are now different types of hormones — delivered at lower doses — that are shown to be safer.

“Women should know that hormone therapy is safe and beneficial,” says Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.

Looking back, Dr. Streicher says, it’s clear the Women’s Health Initiative study was flawed and that some of the risks that were identified were linked to the type of hormones that women were given.

“We learned what not to do,” Streicher says. The type of progestin used, known as medroxyprogesterone acetate, was “highly problematic,” she says. This was likely responsible for the increase in breast cancer seen among women in the study. “So we don’t prescribe that anymore,” Streicher says.

Increasingly, other types of hormones are used, such as micronized progesterone which does not increase the risk of breast cancer, ” Streicher says. Micronized progesterone is a bioidentical hormone that has a molecular structure identical to the progesterone produced by womens’ ovaries, and tends to have fewer side effects.

Another problem with the study was the age of the women enrolled. Most of the women were over the age of 60, Streicher says .” And we know that there is a window of opportunity when it is the safest to start hormone therapy and that you get the most benefit.” That window is typically between ages 50 and 60, she says.

Another risk identified in the Women’s Health Initiative study, was an increased incidence of pulmonary embolism among women taking hormones. A pulmonary embolism is a blood clot that blocks blood flow to the lungs.

Since women in the study were taking estrogen orally, by pill, this may have increased their risk, Streicher says. A better option for people at risk of clots is to take estrogen through the skin, via a patch, a cream or gel.

“The advantage of a transdermal estrogen is that it is not metabolized by the liver,” Streicher says. “And because it’s not metabolized by the liver, we don’t see that increase in blood clots.”

With a range of hormone therapies available now, Dr Streicher says there’s not a one-size fits all approach. “Hormone therapy is beneficial way beyond the benefits to just helping with hot flashes,” she says. Ongoing research points to protection against bone loss and heart disease, too.

Streicher says women should talk to their healthcare providers about what options may best suit their needs.

This story was edited by Jane Greenhalgh

Fed decision: The US Federal Reserve is expected to keep the federal funds rate on hold at the conclusion of its two-day meeting. After a series of hotter than expected employment and inflation figures, investors will be listening for clues on when the central bank expects to cut interest rates.

US employment: US government data is expected to show that job openings in March edged down to 8.69mn from 8.75mn in February. Separately, ADP will release its US employment report for April, which will give some insight into the labour market before the official government figures on Friday. Private payrolls are expected to have added 175,000 jobs in April, compared with the 184,000 jobs added in March.

Pfizer: The pharmaceutical company is expected to report that quarterly revenue declined 23.4 per cent from the same period last year to $14bn, according to LSEG, as the company faces weak demand for its Covid-19 vaccine and antiviral medicine.

Other companies: CVS Health, KKR, Marriott International, Estée Lauder, Kraft Heinz, Yum Brands, and Norwegian Cruise Line will report earnings before the bell. DoorDash, eBay and Etsy will report after the markets close.

Manufacturing: Activity in the US manufacturing sector is expected to have remained in expansion territory, but April’s reading is forecast to have ticked down 0.3 percentage points to a reading of 50.

Two Republican state senators are expected to join Democrats in Arizona on Wednesday to pass a bill to repeal the state’s Civil War-era near-total abortion ban — three weeks after the state Supreme Court ruled the law was enforceable and one week after the House passed its own legislation to roll back the restrictions that have stirred widespread controversy.

GOP state Sens. T.J. Shope and Shawnna Bolick have both indicated they will support the Democratic-led repeal effort, giving Democrats the necessary votes in the chamber.

Notably, Bolick is married to one of the state Supreme Court justices who voted to reinstate the 1864 law, which supersedes a 15-week abortion ban that was enacted in 2022 and which blocks all abortions except to save the life of the pregnant woman.

While Republicans in the state Senate could delay the repeal vote with procedural hurdles, Arizona Gov. Katie Hobbs, a Democrat, has expressed confidence the repeal bill will pass Wednesday.

Hobbs has also expressed frustration that the Legislature didn’t take action sooner, noting that unless the courts impose a pause on the 1864 abortion ban, there could be a monthslong gap between when it goes into effect and then its repeal kicks in.

As of Tuesday morning, the office of Attorney General Kris Mayes said the effective date for the ban has been pushed from June 8 to June 27, after the state Supreme Court rejected a motion to reconsider. If the ban is repealed by the Legislature, that move wouldn’t take effect until 90 days after the legislative session ends, which must be by June 30, meaning the repeal of the 1864 law may not take effect until around Oct. 1.

Some Democrats have acknowledged “uncertainty” that at least two GOP senators will vote for repeal on Wednesday “because the Republican Party has moved to the extremes since Trump first got elected,” Sen. Priya Sundareshan, a Democrat, said on a call with reporters on Tuesday.

Conservatives in the state House initially resisted efforts to fast-track legislation to undo the ban.

“Legislatures are not built for knee-jerk reactions,” state House Speaker Ben Toma said during one floor session.

He has also said that “abortion is a complicated topic — it is ethically, morally complex. I understand that we have deeply held beliefs, and I would ask everyone in this chamber to respect the fact that some of us who believe that abortion is in fact the murder of children.”

Anti-abortion groups have also rallied around the state Capitol seeking to urge lawmakers to stick by the ban. Arizona voter Desiree Mayes, a Republican, told ABC News last mont that “if you really if you really believe that babies in the womb are precious and valuable, they deserve equal protection,” she said, explaining she doesn’t support exceptions for rape or incest.

But Democrats, locally and across the country have called out the ban — as have some Republicans who otherwise say they oppose abortion, like Donald Trump. Three Republicans in the state House ultimately joined the Democratic minority to repeal the law.

“This is a stain on history that this ban even exists — from a time when the age of consent was 10, from a time when women didn’t have the right to vote,” Arizona state Sen. Eva Burch, a Democrat, previously told ABC News’ Elizabeth Schulze.

Anti-abortion groups are encouraging supporters of the near-total ban to again gather on the Capitol grounds on Wednesday to pressure Republicans to stick together and not join Democrats. Meanwhile, Arizona for Abortion Access organizers continue to gather signatures for a potential ballot initiative that would go before voters in November and would protect abortion up to the point of fetal viability, around 24 weeks into pregnancy.

House Republicans are considering proposing their own ballot measures for November to counter the pro-abortion access initiative.

“We don’t deserve to win the legislature if we cannot get it right on the basic tenets of our Republican platform, which is life,” said state GOP Sen. Anthony Kern.

If the repeal bill does not pass the state Senate, Democratic Sen. Sundareshan said her party would “keep fighting” by reintroducing bills or motions.

“We’ll do whatever is available to us to continue to fight to repeal this ban,” she told reporters on Tuesday. “And we will continue fighting to repeal all of the bans that remain on the books.”