Flaming the fires of HRT: what influences risk?

Posted by on Mar 4, 2011 in heart disease, HRT | 6 comments

Let’s face it. Despite my doubts about hormone replacement therapy (HRT), just like the Energizer Bunny, it’s going to keep on going. So as any responsible journalist must do, I have to share the good along with the bad and ugly. The trouble is that data rarely agree, lending confusion to the growing controversy about health risks, appropriate timing, combination and use of HRT.

Last week, several of you sent me a link to a study in the current issue of Menopause that appears to further clarify use of HRT and heart disease risk. Quite honestly, I had seen the study but was hesitant to write about it for fear of simply fueling the fires. But you’ve asked so I’ve answered.

The investigators of this particular study note that experts suspect that timing of hormone replacement, i.e. age when it’s started or time since menopause has begun when it’s started, plays a role in some of the differences between previous reports on HRT and heart disease. For example, reanalysis of data from the Nurses Health Study demonstrates that any heart benefits of HRT rely on starting therapy within 10 years of menopause, while data from the Women’s Health Initiative show that younger age plays an important role as well.

In a quest to tease this out further, they examined information on deaths from ischemic heart disease, age at first and/or current use of HRT, prior use and duration of use in 71,237 postmenopausal women in the California Teachers Study over a period of approximately 9 years. The findings?

  • Overall, current age while using HRT appears to influence risk of dying from any cause. This factor appears to be much more importan than age that HRT was started or years since menopause began. Indeed, women using HRT at the time of the study who were younger than 65 years were found to have a 45% reduced risk of death from any cause compared to women who had never used HRT.
  • Similar findings were seen when the researchers examined death from heart disease, with HRT providing some protection in younger current users that virtually disappeared once they reached 75 years.

The upshot is that the health consequences and risks of HRT may be influenced most by age at current use, with younger women having the most benefits to gain. Any sort of protection starts to disappear as women grow older so the window of opportunity might be small.

Still, questions remain. These researchers were only trying to determine the most important influencer(s) of death from heart disease and not examining cancer or other risks that have been definitively demonstrated.  Do these data fan the controversial fires and serve to heat up the debate? I believe that they do.

As always, buyer beware. Nothing is ever as it seems. Especially when it comes to hormone replacement therapy.


  1. 3-4-2011

    Thanks for this post, Liz. As someone who started HRT after a very early onset of menopause, I am somewhat comforted.

    At least I am comforted until the next study comes out.

    • 3-4-2011

      Thanks Candace. This is why I am becoming ever so hesitant to continue to write about these findings. I think that it’s pretty clear that there are risks associated with taking HRT, risks that grow as we age. Probably the best action is to use them for the shortest period of time possible or unless symptoms are unbearable. Frankly, I’m all for herbs, all the way. Not only have they shut down my symptoms but those of other women I know. It’s all about hitting the right combination. Thanks for commenting.

  2. 3-5-2011

    Thanks for the post. Here’s another good article from Women to Women on HRT risk http://www.womentowomen.com/bioidentical-hrt/womenshealthinitiative-newfindings.aspx

  3. 3-7-2011

    Thanks for this post Liz! I know that you are not a fan of HRT, but that you try to be open and fair about the research out there. It’s important for women to have all the facts available, in order for each of us to make the best personal decisions. I was a little confused about the last paragraph of your post. You state “that the researchers were only trying to determine the most important influencer(s) of death from heart disease and not examining cancer or other risks that have been definitively demonstrated.” However, earlier in your post you report that the studies found that women under 65 years of age who took HRT had a 45% lower risk of death from all causes. I’m assumed that meant cancer and other diseases, not just heart disease? Can you clarify this? Thanks again for another thought-provoking post!

    • 3-7-2011

      Debra, you are as confused as me! All cause mortality typically looks at generally mortality rates amongst a certain population set. So, according to the researchers, the women of a certain age had a lower risk of death. Moreover, they were looking strictly at heart disease. So they didn’t look at other diseases specifically. And it’s been definitively proven that HRT causes breast cancer in certain women. Does this help to answer your question?

  4. 3-8-2011

    Yes it does. Thanks Liz!

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