Ongoing research seems to confirm that, when properly applied for an appropriate period of time (as determined by a patient’s personal medical history), hormone replacement therapy can have

wide-ranging benefits. A Queen Mary University of London study, published in March, indicates that postmenopausal women on HRT for an average of eight years had better cardiac health and

improved blood flow through their heart chambers than did those not receiving the therapy. “Once people get an idea in their minds that something is not good, it’s very difficult to change,”

even with evidence, says Philip M. Sarrel, professor emeritus of obstetrics, gynecology and reproductive services, and of psychiatry, at the Yale School of Medicine.  THE NEW WINDOW FOR HRT

of those cancers. “Estrogen is the best treatment for symptoms,” says epidemiologist Deborah Grady, interim director of the Clinical and Translational Science Institute at the University of

California, San Francisco, School of Medicine. But going back to the pre-2002 days, when estrogen was given as a matter of course to aging women, would be a mistake, she adds.   At the time

of the WHI trials, Grady notes, “women were being put on estrogen for prevention of heart disease and fracture, and left on treatment for life. I believe that when vasomotor symptoms [such

as hot flashes] resolve, HRT should be stopped.” She recommends that women who use HRT discontinue treatment each year, under the supervision of a doctor, to see if their symptoms can be

managed without the medicine.  Many professional medical societies, such as the American Heart Association, agree that the blanket use of estrogen is a mistake. In December 2017 the U.S.

Preventive Services Task Force recommended against hormone replacement for the prevention of chronic disease in menopausal women. “We found that, overall, in the balance of benefits and

harms, this has more harm than benefit,” says David Grossman, a Seattle pediatrician who chairs the task force. “We want to make clear to the public and to primary care clinicians that the

long-term use of these drugs is harmful.” Even Manson, who advocates hormone use when appropriate, warns of its risks in older women if they are not evaluated thoroughly for safety. And

despite studies that show that HRT, when started early, has been helpful in staving off chronic disease, Manson reiterates that “it should not be used for the exclusive purpose of trying to

prevent heart disease, cognitive decline and other chronic diseases of aging.” But despite those caveats, Manson asserts that there is an array of treatment options available for women who

would otherwise benefit if it weren’t for the general lack of education around HRT in the medical community. “There is a whole generation of women not getting answers about the benefits and

risks of different treatments,” she says. Take, for example, products such as Estring or Vagifem, localized estrogen treatments for urogenital atrophy, which can cause a dry, itchy vagina,

painful sex, and incontinence. Although these specific medications were not tested in the WHI and are formulaically much different from the estrogen used in the trial, they continue to carry

physician warning labels that cite the increased risk of heart disease, stroke and cancer that was originally associated with that study. “It really does a disservice to have that on

there,” says Carolyn Wilson, a gynecologist at the Midlife Health Center at the University of Virginia.  “People think, it’s gonna cause heart attack, stroke, blood clots, breast cancer, and

they don’t take it,” says Wilson, who in November testified before the Food and Drug Administration to lobby for new labeling for localized estrogen. And while just 25 percent of women with

vaginal atrophy get treated for it, taking topical estrogen could in fact bring multiple health benefits: When researchers reviewed the records of nearly 46,000 women in the WHI who did not

take oral estrogen, they found that those who instead used vaginal estrogen experienced a 61 percent lower risk of heart disease and a 60 percent reduction in hip fractures than did those

who used nothing.