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Hormones for menopause are safe, study finds. Here's what changed
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
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Supreme Court blocks redrawing of New York congressional map, dealing a win for GOP
The Supreme Court
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The Supreme Court on Monday intervened in New York’s redistricting process, blocking a lower court decision that would likely have flipped a Republican congressional district into a Democratic district.
At issue is the midterm redrawing of New York’s 11th congressional district, including Staten Island and a small part of Brooklyn. The district is currently held by a Republican, but on Jan. 21, a state Supreme Court judge ruled that the current district dilutes the power of Black and Latino voters in violation of the state constitution.
GOP Rep. Nicole Malliotakis, who represents the district, and the Republican co-chair of the state Board of Elections promptly appealed to the U.S. Supreme Court, asking the justices to block the redrawing as an unconstitutional “racial gerrymander.” New York’s congressional election cycle was set to officially begin Feb. 24, the opening day for candidates to seek placement on the ballot.
As in this year’s prior mid-decade redistricting fights — in Texas and California — the Trump administration backed the Republicans.
Voters and the State of New York contended it’s too soon for the Supreme Court to wade into this dispute. New York’s highest state court has not issued a final judgment, so the voters asserted that if the Supreme Court grants relief now “future stay applicants will see little purpose in waiting for state court rulings before coming to this Court” and “be rewarded for such gamesmanship.” The state argues this is an issue for “New York courts, not federal courts” to resolve, and there is sufficient time for the dispute to be resolved on the merits.
The court majority explained the decision to intervene in 101 words, which the three dissenting liberal justices summarized as “Rules for thee, but not for me.”
The unsigned majority order does not explain the Court’s rationale. It says only how long the stay will last, until the case moves through the New York State appeals courts. If, however, the losing party petitions and the court agrees to hear the challenge, the stay extends until the final opinion is announced.
Dissenting from the decision were Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson. Writing for the three, Sotomayor said that if nonfinal decisions of a state trial court can be brought to highest court, “then every decision from any court is now fair game.” More immediately, she noted, “By granting these applications, the Court thrusts itself into the middle of every election-law dispute around the country, even as many States redraw their congressional maps ahead of the 2026 election.”
Monday’s Supreme Court action deviates from the court’s hands-off pattern in these mid-term redistricting fights this year. In two previous cases — from Texas and California — the court refused to intervene, allowing newly drawn maps to stay in effect.
Requests for Supreme Court intervention on redistricting issues has been a recurring theme this term, a trend that is likely to grow. Earlier last month the high court allowed California to use a voter-approved, Democratic-friendly map. California’s redistricting came in response to a GOP-friendly redistricting plan in Texas that the Supreme Court also permitted to move forward. These redistricting efforts are expected to offset one another.
But the high court itself has yet to rule on a challenge to Louisiana’s voting map, which was drawn by the state legislature after the decennial census in order to create a second majority-Black district. Since the drawing of that second majority-black district, the state has backed away from that map, hoping to return to a plan that provides for only one majority-minority district.
The Supreme Court’s consideration of the Louisiana case has stretched across two terms. The justices failed to resolve the case last term and chose to order a second round of arguments this term adding a new question: Does the state’s intentional creation of a second majority-minority district violate the constitution’s Fourteenth and Fifteenth Amendments’ guarantee of the right to vote and the authority of Congress to enforce that mandate?
Following the addition of the new question, the state of Louisiana flipped positions to oppose the map it had just drawn and defended in court. Whether the Supreme Court follows suit remains to be seen. But the tone of the October argument suggested that the court’s conservative supermajority is likely to continue undercutting the 1965 Voting Rights Act.
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Map: Earthquake Shakes Central California
Note: Map shows the area with a shake intensity of 3 or greater, which U.S.G.S. defines as “weak,” though the earthquake may be felt outside the areas shown. The New York Times
A minor earthquake with a preliminary magnitude of 3.5 struck in Central California on Monday, according to the United States Geological Survey.
The temblor happened at 7:17 a.m. Pacific time about 6 miles northwest of Pinnacles, Calif., data from the agency shows.
As seismologists review available data, they may revise the earthquake’s reported magnitude. Additional information collected about the earthquake may also prompt U.S.G.S. scientists to update the shake-severity map.
Source: United States Geological Survey | Notes: Shaking categories are based on the Modified Mercalli Intensity scale. When aftershock data is available, the corresponding maps and charts include earthquakes within 100 miles and seven days of the initial quake. All times above are Pacific time. Shake data is as of Monday, March 2 at 10:20 a.m. Eastern. Aftershocks data is as of Monday, March 2 at 11:18 a.m. Eastern.
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US says Kuwait accidentally shot down 3 American jets
The U.S. and Israel have been conducting strikes against targets in Iran since Saturday morning, with the aim of toppling Tehran’s clerical regime. Iran has fired back, with retaliatory assaults featuring missiles and drones targeting several Gulf countries and American bases in the Middle East.
“All six aircrew ejected safely, have been safely recovered, and are in stable condition. Kuwait has acknowledged this incident, and we are grateful for the efforts of the Kuwaiti defense forces and their support in this ongoing operation,” Central Command said.
“The cause of the incident is under investigation. Additional information will be released as it becomes available,” it added.
In a separate statement later Monday, Central Command said that American forces had been killed during combat since the strikes began.
“As of 7:30 am ET, March 2, four U.S. service members have been killed in action. The fourth service member, who was seriously wounded during Iran’s initial attacks, eventually succumbed to their injuries,” it said.
Major combat operations continue and our response effort is ongoing. The identities of the fallen are being withheld until 24 hours after next of kin notification,” Central Command added.
This story has been updated.
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