Any regular reader of this blog knows that I am not a fan of hormone replacement therapy (HRT) nor the health risks associated with it. Nevertheless, although I espouse alternative strategies for dealing with menopause, I do feel that sharing news about HRT is important; accurate information leads to informed and shared decisionmaking.
So, do they (i.e. hormones) or don’t they (cause harm)? Undoubtedly, important variables come into play, including current age, how close to menopause hormones are started, current health status, whether or not a woman has had a hysterectomy, smoking history, etc. Also important is whether estrogen is used alone or in combination with progesterone. And yet despite these factors, many medical organizations continue to recommend that HRT be used for the shortest time period possible if at all.
Still, researchers continue to delve into data from the now infamous Women’s Health Initiative Study to tease out the bad, ugly and even the good.
This week, they are reporting on over 7,600 women who had taken estrogen alone for approximately 6 years, had had prior hysterectomies and were followed for an average of 10 years after the trial ended. If you recall, there has been some controversy as to whether or not estrogen alone is safer than combined HRT and actually lowers the risk for breast cancer in particular, which is why these data are particularly intriguing.
The researchers report that age at the time that hormone therapy (in this case, estrogen alone) is started is important. In fact, women who started estrogen therapy in their 50s, an increased risk for stroke and embolism, which appeared while taking estrogen, actually disappeared in the years that followed. Unfortunately, so did protection against hip fracture. Moreover, earlier reports of a decline in breast cancer risk were upheld despite body mass indices. However, the researchers say that this finding in particular, runs contrary to the preponderance of evidence from the majority of observational studies which show that estrogen use increases the risk of breast cancer, especially in lean women and after a long time period of use.
In an accompanying editorial, also in JAMA, the authors point out that more than 80% of women who took estrogen as directed only used it for an average of 3.5 years. Their point is that the results don’t directly address the “balance of risk and benefits associated with longer term estrogen use.” They also point to a larger review of data that show duration is an important factor when it comes to breast cancer risk, especially among lean women. Additionally, they say that tamoxifen, which actually antagonizes estrogen, has been shown to reduce breast cancer by 50%, which has led the International Agency for Research on Cancer to “conclude that unopposed estrogen therapy and combination HRT are carcinogenic.”
Are you confused yet?
Both set of researchers say that the decision to use estrogen or not is one that should be made between a woman and her doctor. Don’t forget: study findings continue to contradict. They add that while “there may still be a role for short-term use of unopposed estrogen for treating some women with menopausal symptoms, this role may be vanishing as existing and emerging data continue to be better understood in terms” of patients.
My thoughts? Err on the side of caution. Always.
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Liz, Like you, I’m unsure of the significance of the latest findings. And I’m sure I agree with your conclusion, most of the time.
Thanks Elaine. The data continue to contradict and confuse. I do believe that there will be a divide: pro or anti-HRT, for years to come. It’s unfortunate because it places physicians in an odd position in terms of making responsible recommendations, and patients in an odd position of just being too confused to make an informed decision. I welcome your thoughts and comments.
I’ve always been wary of hormone treatments for benign conditions, not only in this context.
I don’t believe that we know enough about how hormones behave in the body to be prescribing them with such frequency.
At the risk of playing the devil’s advocate – we are all afraid of the known and potential dangers of hormone therapy for menopausal symptoms, but what about birth control pills? Is the pill not just as dangerous as HT? And, what about hormone medication for other hormonal conditions, such as low thyroid? HT is used to treat this medical condition. What about those who go into early menopause? Isn’t HT a good alternative for these women? With all the advances in medicine we now are able to live much longer and healthier lives. I know menopause is not a medical condition for most (with the exception of early menopause) but what about the fact that women now live well past menopause, whereas in the past, this was not the case. In other words, what do we really know?!! If we can prolong life and provide better quality of life for various medical conditions that were once a life sentence, what about a better quality of life in general? There are so many different hormones in the body that we rely on for various functions, what makes estrogen so much scarier, and why don’t we need it after 50 as well? I’m sorry, lots of questions, but no answers! Just wondering?
Debra – yes, you do have a lot of questions. I am not a physician nor do I play one on the Interwebz. I try to provide factual information on strategies that we can use other than hormones to address some of the troublesome things that happen to our bodies as we age. I can no more answer the question about what makes estrogen scarier than researchers can. All I can tell you is that studies show that replacing it after if starts to disappear in the body appears to have a negative effect on our health. Early menopause is often treated with hormone therapy. However, these groups of women have not be adequately evaluated in the literature in terms of examining health risks. If you visit my friend over at Medical Lessons, a physician, she doesn’t promote the use of hormones and in fact has commented on this blog to that. For me, hormones are an easy choice – no. I’d rather find the right combination of alternatives that build bones, prevent or ameliorate flashes and assist with other declines in health risks.
Thanks for your reply Liz! I was not really asking you these questions, as I know we don’t have many answers right now. But, I often wonder about the differences between all the various hormones that our bodies rely on. Why we need some all our lives, while others,like estrogen, are dangerous if supplied for too long. Wonder if they’ll discover at some point that, like everything else in the body, it’s a matter of finding the ideal balance. For example, those with an over or underactive thyroid just need take the correct amount of the hormone to put things right. Anyway, I always look forward to reading your blog Liz. Thanks for all your hard work!
The bottom line to me is to ask hard questions. And ask lots of them even if you get push back from providers. I found this video helpful: http://whatstherealcost.org/video.php?post=five-questions
Absolutely Susan. But, we should ask the hard questions about every bit of advice we get, whether it’s from physicians or insurers or financial advisors or whatever. Informed decision making is powerful decision making.