Hormone Therapy for Menopausal Vasomotor Symptoms

Vasomotor symptoms (VMS) such as hot flashes and night sweats are common in menopausal women and severely impact quality of life in many. Hormone therapy (HT) is the most effective treatment for VMS, but there has been debate for years about its cardiovascular safety. In this issue of JAMA Internal Medicine, Rossouw et al provide updated analyses of data from the Women’s Health Initiative (WHI) randomized clinical trials to assess the safety of HT for treatment of menopausal VMS. The WHI trials, perhaps the most well-known studies ever completed in women’s health, were designed to address whether treatment with estrogen or estrogen plus a progestin could reduce the risk of coronary heart disease (CHD) in older women. The trials were not designed to evaluate the effect of HT on menopausal VMS. The WHI trials of both HT formulations were stopped early due to harm, which resulted in a marked reduction in the use of HT. Prior post hoc analyses of WHI data and other studies have suggested an important effect of age on risk for adverse CHD events, with HT not increasing risk of CHD in younger postmenopausal women (those aged 50 to 59 years); thus, HT might remain a safe first line treatment for VMS in women in this age group.