Hormone therapy remains a reasonable choice for some postmenopausal women who want short-term relief from hot flashes but not for women hoping for long-term protection from the ills of aging, say researchers who on Tuesday released the most detailed report yet on results from the landmark Women's Health Initiative.
The details, based on 13 years of follow-up and published in the Journal of the American Medical Association, show a complex mix of risks and benefits for women who take estrogen either alone or with progestin. But, on balance, the risks -- including increases in heart disease and breast cancer for many women -- outweigh the benefits when the hormones are used for anything other than relief of moderate to severe menopause symptoms, the researchers say.
That's a message these researchers have conveyed with increasing confidence since their first preliminary results were published in 2002. The cumulative findings have succeeded in "shattering the dogma" that hormone therapy would prevent heart disease and other chronic diseases of aging, says an editorial by Elizabeth Nabel, president of Brigham and Women's Hospital in Boston and former director of the National Heart Lung and Blood Institute, that accompanying the study.
Hormones Are No Cure-All
As a result, there has been a large drop in the percentage of postmenopausal women in the USA who take hormones -- just 4.7% in 2009-10 vs. 22% 1999-2000, according to the National Health and Nutrition Examination Survey.
"Hormone therapy was being used too widely," says JoAnn Manson, lead author of the new report and chief of preventive medicine at Brigham and Women's. Yet, she says, nothing about the previous or newest findings should stop women and their doctors from considering hormones when hot flashes, vaginal dryness and other menopausal symptoms are seriously disrupting life in the early menopausal years. Older women should be more cautious, even if they still have hot flashes, she says, because their risks are higher.
The newly published data are based on more than 27,000 women ages 50 to 79 who took either placebos or hormones for an average of five to seven years, starting in 1993. Some took combined estrogen and progestin; others took estrogen alone. The women were followed for several years after stopping therapy, for a total of 13 years.
Among the highlights:
--Those in their 50s generally saw the most benefits and fewest risks.
--Combined estrogen and progestin therapy carried more risk than estrogen alone, largely because it increased the risk of breast cancer. It also increased dementia in women older than 65. Still, estrogen-only therapy can be used only by women who have had hysterectomies because progestin protects against uterine cancer. (continued...)
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Posted: 2013-10-14 @ 6:50pm PT
If I hear one more article sourcing the women's health initiative as the standard by which hormone replacement therapy advice should be generated, I think I'm going to puke. Citing the women's health initiative equates with attending the Flat Earth Society Conference and listening to people try to prove the earth is flat. The women's health initiative is a dead paradigm that needs to be buried. Stop exhuming the women's health initiative. The women's health initiative is nothing but an embarrassment to all physicians, and I'm not sure why they have not retracted all the statements that came out of that joke of a study.