After years of confusion over its safety, hormone replacement therapy is now being recommended as a treatment for the symptoms of menopause in new guidelines released Tuesday.

The Society of Obstetricians and Gynecologists of Canada says women can go on HRT to relieve moderate to severe symptoms such as hot flashes, night sweats and mood changes.

"A very key message for women who are having symptoms and are afraid of hormone therapy is for managing their symptoms, they can safely use hormones," said Dr. Jennifer Blake, co-chair of the group that wrote the consensus report on menopause.

Dr. Jennifer Blake
Dr. Jennifer Blake

It's the group's first attempt at clarifying the safety of HRT since a landmark trial, called the Women's Health Initiative, was stopped in 2002.

Researchers discovered combined estrogen and progestin therapy increased women's risk of breast cancer, heart disease and stroke, compared to those study subjects taking a placebo.

Since then, doctors have been looking for guidance on whether it was safe to prescribe HRT and for how long.

Gwynne Basen
Gwynne Basen

The society's report recommends that HRT be prescribed at the lowest effective dose to manage moderate to severe symptoms "for the appropriate duration," although this isn't defined.

Quelling breast cancer fears

The new guidelines reflect a shift away from using hormone therapy for prevention and towards prescribing it for symptoms, Blake told a news conference.

If 1,000 women were to take hormone therapy for 10 years, there would be six extra cases of breast cancer – an increased risk similar to delaying childbirth until after age 30, said Blake, chief of obstetrics and gynecology at Sunnybrook and Women's College Health Sciences Centre in Toronto.

The new guidelines also say:
  • Health-care providers should discuss and encourage menopausal women to make healthy lifestyle choices, including practising good nutrition and exercising.
  • HRT may be prescribed for extended periods after proper counselling if a women decides the benefits outweigh the risks. Periodic re-evaluations are strongly recommended.
  • Doctors are urged not to prescribe HRT for the prevention of heart disease or dementia.
  • Lubricants or creams with low amounts of estrogen may help to relieve vaginal symptoms.
  • Complementary and alternative medicine such as black cohosh, vitamin E or hormones derived from red clover can be taken to relieve mild hot flashes or night sweats.

When filmmaker Gwynne Basen of Dunkin, Que. hit menopause at age 48, she tried adjusting her diet with tofu and taking herbal remedies, but the night sweats disrupted her sleep.

"There was a certain sense of ... almost capitulating to the medicalized model that made me a bit uncomfortable," said Basen. The symptoms nearly disappeared with hormone therapy, she said.

The group's guidelines were based on a review of clinical and scientific research on menopause.

Despite the new guidelines, it's not clear when doctors should prescribe HRT, partly because the long-term risks and benefits of the therapy haven't been determined.