Short-term estrogen may be safe for menopause

NEW YORK (Reuters Health) - In healthy women, short courses of estrogen, given for up to 3 years to treat hot flashes and other bothersome symptoms of menopause, are associated with a relatively low rate of endometrial hyperplasia, an abnormal thickening of the lining of the uterus that can lead to cancer and that has been associated with estrogen-only hormone therapy.

That's according to Dr. Wendy Mack of the University of Southern California, Los Angeles, and colleagues who reviewed results of two studies in which healthy menopausal women were treated with estrogen only hormone therapy or placebo.

Ninety-six women were assigned to estrogen therapy and 122 to placebo daily for up to 3 years. Women had annual measurements of endometrial thickness using vaginal ultrasound.

Ultrasound tests showed that 9 of the 96 women on estrogen developed endometrial hyperplasia (9.4 percent) and eight of these nine women (88.9 percent) had only "simple hyperplasia."

At three years, the incidence of bleeding in the uterus was 67 percent in those estrogen and 11 percent in those on placebo. Obesity markedly increased the risk of "uterine bleeding."

In a report in the journal Obstetrics and Gynecology, Mack and colleagues note that, in some women, estrogen-only hormone therapy "may be necessary...to control symptoms of menopause."

In these women, the benefits of estrogen may outweigh the risks, they charge, with the length of treatment influencing the risk of cancer. These women should be advised of the risk of uterine bleeding and that biopsy of endometrial tissue may be needed.

SOURCE: Obstetrics and Gynecology, March 2007.