While medicines containing the female hormones estrogen and progestin are highly effective at reducing the symptoms of menopause, risks associated with taking them outweigh the benefits for most women, according to a new report from Consumer Reports Best Buy Drugs.

It's the latest in a series of reports that compares commonly used prescription drugs on effectiveness, safety and price. All reports are available free at www.CRBestBuyDrugs.org.

Studies evaluated for the Best Buy Drugs report show that between 70 percent and 90 percent of women who have hot flashes or night sweats experience an average 75 percent reduction in these symptoms within a few months of taking hormones medicines.

The drugs also effectively reduce vaginal dryness and help with sleep disturbances.

Hormone treatment, however, increases the risk of heart disease, breast cancer, blood clots, stroke, urinary incontinence and dementia. Although the increased risk is relatively small, it adds on to already-existing risk factors for tens of millions of women.

For example, a woman who has high blood pressure and diabetes is already at elevated risk for heart attack and stroke. Taking hormones adds to that risk.

Similarly, a woman who has high cholesterol and a family history of early heart disease and breast cancer would add to existing elevated risk if she took hormones.

For that reason, the report recommends that the vast majority of women who have an elevated risk of heart disease, stroke, or cancer of the breast, ovaries, or uterus not take hormones. This represents 35 percent to 50 percent of all women aged 50 and older.

In addition, studies show that while 70 percent of women entering menopause will have some symptoms, most will have mild symptoms that can be managed with lifestyle changes and adjustments. Only about 20 percent of women have severe symptoms that significantly disrupt their lives or reduce their quality of life.

The reports states for such women, hormone treatment may be warranted. Treatment should be with as low a dose as possible for the shortest duration possible. The risk associated with such use appears to be quite low, but definitive studies on that are not yet complete.

Hormones should not be used at all, the report says, to treat mood swings, irritability, depression, anxiety, mental lapses, forgetfulness, cognitive difficulties, reduced libido, urinary incontinence, back pain, chronic pain, joint pain, stiffness, or fatigue. They dont help these conditions and could make them worse.

The report also recommends caution in using herbs, supplements, and bioidentical hormone products as alternatives to estrogen and progestin for women who do require treatment. These products are widely touted but lack proof of effectiveness and safety.

Taking effectiveness, safety, the choice for mode of delivery, and cost into account, the reports chooses the following as Consumer Reports Best Buy Drugs for treating menopausal symptoms:
• Generic estradiol pills
• Gynodiol pills (estradiol)
• Estratab or Menest pills (esterified estrogen)
• Generic medroxyprogesterone pills (when a progestin alone is needed)
• Generic estradiol patch
• Alora patch (estradiol)
• Vivelle or Vivelle Dot patch (estradiol)
• Premarin Cream (conjugated equine estrogen)
• Ogen Cream (estropipate)
• FemRing (estradiol, vaginal ring)
• Estring (estradiol, vaginal ring)

Most of these products are used to treat all menopausal symptoms. The creams and FemRing are used primarily to treat vaginal dryness.

All the Best Buys are as effective as other hormone drugs, but less expensive. In particular, the two estradiol pills could save consumers $300 to $450 a year out-of-pocket compared to brand name Premarin. Similarly, the generic estradiol patch could save women $200 to $400 a year over higher-priced products.

Consumer Reports Best Buy Drugs is a grant funded public information project administered by Consumers Union.