In the decade since a landmark study uncovered the risks of taking hormone replacement therapy for disease prevention, some doctors have shied away from prescribing the drugs even for women with severe hot flashes and other menopausal symptoms. But the latest follow-up data from the Women’s Health Initiative trial involving 27,000 postmenopausal women suggest that the benefits of symptom relief outweigh the risks — at least for women in their 50s.
Among women between 50 and 59, increased risks associated with taking a combination of estrogen and progesterone — such as strokes, blood clots, and breast cancer — were very small, less than 1 percent during the five years they were taking the hormones, according to the research published Tuesday in the Journal of the American Medical Association.
“Women in the trial who were still experiencing menopausal symptoms had significant improvement in these symptoms when taking hormone therapy compared to a placebo and had a very low risk of adverse events,” said Dr. JoAnn Manson, principal investigator of the Women’s Health Initiative and chief of preventive medicine at Brigham and Women’s Hospital.
While the heightened breast cancer risk was small, it persisted for at least six years after women stopped taking the combination therapy. But hormone users also gained some protection from colorectal cancer, diabetes, endometrial cancer, and hip fractures.
“These findings demonstrate that menopausal hormone therapy has a complex profile of risks and benefits,” Dr. Elizabeth Nabel, former director of the National Heart Lung and Blood Institute, wrote in an editorial that accompanied the study. “Even though short-term use of hormone therapy may be useful for menopausal symptom relief . . . long-term use of hormone therapy for chronic disease prevention is not warranted.” Nabel now is president of Brigham and Women’s.
Before the government-funded trial was undertaken, doctors had been routinely prescribing hormones to older women based on observational studies suggesting that women who took hormones had lower rates of heart disease, osteoporosis, Alzheimer’s disease, and other aging-related ills. But the Women’s Health Initiative was a more rigorous study than the earlier ones, and its results were alarming: higher rates of heart disease, strokes, breast cancer, and gallstones were seen in women randomly assigned to take hormones than in women not given the drugs. The trial was abruptly halted, and doctors quickly stopped prescribing hormones for disease prevention. In fact, a recent decline in breast cancer rates has been attributed to the drop in hormone use.
But women’s health experts have argued that the pendulum has swung too far against the drugs, with physicians refusing to use them even for women with severe menopausal symptoms. While other treatments such as antidepressants or antiseizure medications have some efficacy against hot flashes and mood swings, they often don’t work as well as hormones, Manson said.
“Healthy women in their 50s with menopausal symptoms are generally the best candidates for hormone therapy,” she added, “and they should not be denied the treatments based on the Women’s Health Initiative.” Most of the women in the trial were 60 or older.
The new findings also provided crucial information on the risks and benefits of taking estrogen alone, a regimen only given to those who have previously had hysterectomies since it can increase the likelihood of uterine cancer. Younger women who took estrogen did not have an increased risk of breast cancer and enjoyed protection against heart attacks and colon cancer. But these benefits vanished in older women who took only estrogen.