A Boost for Hormone Therapy

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Progesterone in tablet form, used in hormone replacement therapy.

For women trying to keep track of the confusing research on hormone replacement therapy over the past five years, the release of yet another study may not sound like good news. But the latest report, published in the New England Journal of Medicine, helps clarify some of the conflicting results,and offers some reassurance for women wondering whether such hormone therapy is safe.

The Journal study is continuation of the landmark Women's Health Initiative (WHI), the largest and longest-running survey of the effects of hormone therapy in post-menopausal women. It was the WHI, back in 2002, that turned everything that doctors and patients had believed about the benefits of hormone therapy on its head. The federally funded trial revealed that estrogen and progestin after menopause did not protect women against heart disease, as doctors had previously thought, but in fact increased their risk of heart attack, stroke and breast cancer. After years of recommending the therapy for women well past menopause, doctors then pulled back, prescribing it only for women having the hardest time with menopausal symptoms of hot flashes and night sweats.

After those surprising results, however, WHI narrowed its focus to study the women most likely to need hormone therapy — those under 60 and just experiencing menopause. And they found that younger post-menopausal women actually enjoyed a lower risk of adverse health effects from hormone therapy than their older counterparts. The new NEJM study specifically reports that women between the ages of 50 and 59 who have had hysterectomies and therefore used estrogen alone (not the estrogen-progestin combination) showed less calcium-based plaque — up to 40% less — in their heart arteries than those on placebo. That's great news for the millions of women struggling with the disruptive symptoms of menopause, but who have been too afraid of the health risks to start hormone therapy. In some cases, even their doctors have been reluctant to prescribe the treatment, after the public lashing the profession received five years ago for "pushing" the therapy so eagerly.

The study is not, however, a free pass for estrogen therapy in all post-menopausal women. "These findings provide reassurance to recently menopausal women who are considering estrogen therapy for treatment of menopausal symptoms, that estrogen is not likely to have an adverse effect on the heart," says Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital and an author of the study. "But it does not mean that women should begin taking estrogen for the express purpose of preventing cardiovascular events because there are other risks of hormone therapy."

Those include the risk of blood clots, stroke and, over a long enough period of time, breast cancer. It's all about balance, and weighing benefits and risks responsibly, says Manson. For women who suffer from the most intense symptoms of menopause, hormone therapy may be worth the slightly increased risk of these conditions, provided that they don't stay on the hormones for more than five years or so. Last April, another study from the WHI supported just this sort of judicious use. That study found that women who began estrogen and progestin, the most commonly prescribed combination (progestinis added to protect against uterine cancer; women with hysterectomies do not need progestin, since they have had their uterus removed), within 10 years of hitting menopause experienced less heart disease than their counterparts who began years after the Change.

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