The hormone wires are abuzz with the latest assessment of the Women’s Health Initiative, the 15 year study that ended in 2002, that frightened many women and physicians away from HRT. For those of us prescribing HRT, this is old news. For conservative groups supported by the pharmaceutical industry, this shift is a major change. While they don’t say, “well, maybe we might have been wrong, or exaggerated the risks of HRT”, they do admit that the data on closer inspection has some interesting findings. So while still somewhat confusing, here are the newest thoughts after further analysis of the WHI.
- Risk for Breast Cancer – Women in the WHI who took estrogen and progestin (not progesterone) had an increased risk for breast cancer with 2.6 breast cancer deaths per 10,000 women compared to women in the placebo group with 1.6 per 10,000 women. Women who took estrogen alone had a 63% lower risk of dying of breast cancer. Based on this data, most of us in the field believe that the culprit is the synthetic progestin.
- For hot flashes, mood swings, irritability, night sweats, heart palpitations, estrogen wins hands down against all other remedies. While lifestyle and some herbals and supplements may help, there is nothing that works as well as estrogen.
- Cardiovascular disease – 400,000 women a year die from heart disease making it the number one cause of death which is more than all cancers combined. This is where it gets a little tricky. For women age 50-59, HRT substantially decreases the risk for heart disease. Oral estrogen has a positive effect on lipid metabolism and is one of the few treatments for Lp(a) which is a significant risk factor for cardiovascular disease. However, HRT should be started early, i.e. within 10 years of menopause, because if a woman already has atherosclerosis, she is at risk for a CV event because the estrogen can precipitate plaque rupture in a woman with established disease. So, start HRT early, and don’t use oral estrogen in someone with risk factors such as hypertension or smoking. Be cautious when starting a woman on HRT that is greater than 10 years out from menopause.
- Stroke – thromboembolism – HRT can increase the risk for blood clots though these risk are reduced with topical or transdermal estrogen. Patients should be assessed for excess risk.
- Osteoporosis – Osteoporosis causes more morbidity and mortality than breast cancer. HRT is safe and effective though must be continued indefinitely to proffer protection.
- Diabetes – HRT may be associated with a decreased risk for Type II Diabetes. More research is needed.
- Colon cancer – In WHI, women had a reduced risk for colon cancer.
- All-cause mortality was lower in the women who took HRT.
- Overall quality of life was greater in the HRT group.
You should talk with a knowledgeable physician who can evaluate you and explain all the nuances of hormone replacement therapy. Just know that HRT is the best option for menopausal symptoms, the previously reiterated risks are exaggerated and taken out of context, and that after review of the WHI and other literature, experts are now acknowledging that the benefits of HRT are many and should not be denied to women.