Until July 2002, hormone therapy had been the standard therapy in the United States for treating menopausal symptoms. Not only did hormone therapy relieve such discomforts as hot flashes and vaginal dryness, but it also seemed to protect against several postmenopausal conditions, such as osteoporosis and heart disease.

But in July 2002, the Women's Health Initiative — a large, multitiered clinical trial sponsored by the National Institutes of Health — reported that hormone therapy actually posed more health risks than benefits for most women. And as the number of health hazards attributed to hormone therapy grew, doctors discontinued routine prescriptions for this popular treatment.

You might be wondering how this shift in opinion over hormone therapy affects you personally. In some cases, hormone therapy is still your best option for treating menopausal symptoms. In other cases, it might be wise to consider alternatives. Learn more about the specific risks associated with hormone therapy, when you should or shouldn't take it, and what other treatments are available.

Concerns about hormone therapy stem from the results of both the combined estrogen-progestin and the estrogen-alone arms of the Women's Health Initiative (WHI) clinical trial.

The study population consisted of older postmenopausal women — the average age was 63 at the start of the trial. It's unknown whether the study findings can be applied to younger postmenopausal women.

For women taking the combination estrogen-progestin used in the study (Prempro), researchers found an increased risk of:

• Heart disease
• Breast cancer
• Stroke
• Blood clots
• Dementia

In addition, not only did hormone therapy increase the women's risk of breast cancer, it also made tumors harder to detect, leading to potentially dangerous delays in diagnosis.

For women taking estrogen alone (Premarin), preliminary results showed no increased risk of breast cancer or heart disease but did find a slightly increased risk of stroke. Taking either estrogen-progestin or estrogen alone also didn’t prevent dementia or mild cognitive impairment (MCI), as was previously believed. Rather, the new data show a trend toward the development of cognitive impairment. Using hormone therapy to prevent dementia or MCI is no longer recommended for women 65 years of age or older.

Also among the accumulated study results, the WHI found that for women in the study — most of whom didn't have troublesome menopausal symptoms — combination hormone therapy didn't provide a meaningful improvement in such quality-of-life measures as sleep, emotional health, general health, physical functioning and sexual satisfaction.

On the other hand, researchers did note a few benefits in the WHI study — including a decreased risk of osteoporosis-related hip fractures and fewer instances of colorectal cancer.

Most experts now agree that hormone therapy isn't the therapy of choice for disease prevention in healthy older women. However, it may still have a place in treating some menopausal symptoms.

Although the number of women who take hormone therapy is diminishing, for some — such as those who have severe hot flashes — the benefits of short-term hormone therapy may still outweigh the risks.

"The absolute risk to an individual woman taking hormone therapy is quite low and may be acceptable to you in light of your symptoms," says Sharonne Hayes, M.D., cardiologist and director of the Women's Heart Clinic at Mayo Clinic, Rochester, Minn. "Talk with your doctor about your personal risks."

Hormone therapy might still be your treatment of choice if you have:

• Hot flashes. Hormone therapy is still the most effective medicine you can take for menopausal hot flashes and night sweats.
• Vaginal discomfort. Hormone therapy can ease vaginal symptoms of menopause, such as dryness, itching and burning.
• Osteoporosis. Hormone therapy continues to be an option for osteoporosis prevention, but it's recommended only when other medications for osteoporosis prevention have been tried or considered.

If you're already taking hormone therapy to relieve menopausal symptoms, you may need to rethink your options.

"Consider the reason you started hormone therapy and whether the reason remains relevant," Dr. Hayes advises. "If you started hormone therapy for hot flashes several years ago, you may no longer have hot flashes and could stop taking the drug."

If you've taken a particular dose of estrogen, you may be able to lower the dose. Sometimes switching from an estrogen pill to a patch may offer benefits, since the patch doesn't affect blood-clotting factors the way the pill can. In treating vaginal symptoms, estrogen as a vaginal cream is usually a better choice than a pill or patch.

If you opt for hormone therapy, take the lowest effective dose for the shortest amount of time needed to treat your symptoms.

Don't take hormone therapy for preventing memory loss, heart disease, heart attacks or strokes. Also avoid hormone therapy if you have a history of breast cancer — HT may increase your risk of this disease.

Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.

You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you try making changes to your exercise or eating habits first before you try medication. If — after trying lifestyle modifications — you're still dealing with bothersome symptoms, you have several options besides hormone therapy to help relieve discomfort.

One of the previously believed benefits of hormone therapy was that it promoted long-term health of postmenopausal women, from reducing your risk of heart disease to making your bones stronger. But since that's no longer the case, here are some alternatives.

A healthy heart
Good-for-your-heart health tips include:

• Don't smoke.
• Be physically active.
• Eat a low-fat, high-fiber diet, plentiful in fresh fruits and vegetables.
• Maintain a healthy weight.
• Manage high blood pressure.
• Keep cholesterol and triglyceride levels in check.
• Control diabetes.
• Avoid excess alcohol.

Healthy bones
Keep your bones healthy and strong with:

• Calcium and vitamin D. Make sure you're getting enough of these nutrients in your diet to keep your bones strong.
• Exercise. Regular physical activity — especially weight-bearing exercises such as walking or dancing — can help keep your bones strong and healthy.

Medicines might also protect your bones:

• Bisphosphonates. Bisphosphonates, such as alendronate (Fosamax) and risedronate (Actonel), prevent bone loss and reduce your risk of bone fractures. Concerns include gastrointestinal intolerance and risk of esophageal ulcers or an inflamed esophagus (esophagitis), especially if you don't take the medicine as prescribed or if you've had reflux or ulcers in the past. Taking a dose intravenously may be an option if you can't take the drug in pill form.
• Raloxifene (Evista). This selective estrogen receptor modulator (SERM) isn't a hormone, but it mimics the action of your body's hormones, providing estrogen-like benefits for bone density. It also reduces the risk of bone fractures in your spine. Unlike hormone therapy, raloxifene doesn't stimulate breast or uterine tissue, so it won't cause breast tenderness or uterine bleeding. Early studies suggest raloxifene might actually decrease your risk of breast cancer. However, raloxifene does carry the same risk of causing blood clots as hormone therapy does, and it can make hot flashes worse for some women.
• Teriparatide (Forteo). This powerful drug, a parathyroid hormone, treats osteoporosis in postmenopausal women who are at high risk of fractures. Unlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. Teriparatide is given once a day by injection to the thigh or abdomen. Long-term effects are still being studied, so the Food and Drug Administration recommends restricting therapy to two years or less.
• Calcitonin. Calcitonin helps maintain bone density and may slow bone loss and prevent fractures. It's not as potent or effective as bisphosphonates for treating osteoporosis. However, calcitonin does offer one additional benefit if you have painful compression fractures due to osteoporosis — it sometimes helps provide pain relief. You usually take calcitonin as a nasal spray, but it's also available as an injection.

When it comes to hormone therapy, no one-size-fits-all solution is available. Each woman's experience with menopause is unique.

As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. Review your current treatments with your doctor on a regular basis to see if they're still your best option.