Hormone Therapy in Early Menopause May Benefit Some Women: Study
WEDNESDAY Oct. 3, 2012 -- New research suggests that hormone replacement therapy, used to relieve hot flashes and other symptoms of menopause, might be safe for younger menopausal women when taken in smaller doses for short periods of time.
Women have shied away from this type of therapy since the landmark Women's Health Initiative study found elevated risks of breast cancer, heart disease and other health problems among women taking estrogen plus progestin, a synthetic form of progesterone. That study was halted early because of the results, published in 2002.
But research scheduled for presentation Wednesday at the annual meeting of the North American Menopause Society in Orlando, Fla., found that estrogen, either in oral form (Premarin) or as a patch (Climara), plus a progesterone (Prometrium) did not harm the heart either in terms of raised blood pressure or hardening of the arteries.
Progesterone is added because estrogen alone can promote uterine cancer.
In another part of the study, hormone replacement therapy did help with mood and depression, researchers from the University of Wisconsin School of Medicine and Public Health found. It did not worsen memory, as the Women's Health Initiative had indicated, the researchers said in a university news release.
The roughly 700 women participating in the study were age 53, on average, and within three years of menopause -- the time when periods stop. This was much younger than the average age of women participating in the Women's Health Initiative, many of whom were taking hormone therapy in the hope of staving off some of the problems of old age, such as heart disease.
The new study, funded by the Phoenix-based Kronos Longevity Research Institute, was too small to assess any effect on breast cancer rates, one of the main concerns of women considering hormone replacement therapy.
Some experts remain unconvinced by these latest findings. Among them is Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.
"I still say the bottom line is if you don't need to take [hormone replacement therapy], don't take it," Brooks said.
"The largest study to date of estrogen plus progestin [the Women's Health Initiative] showed an increased risk of heart disease and breast cancer and stroke, so if your symptoms are so severe you need to take it, understand there's a risk," he added. "And take as low a dose as possible for as short a time as possible."
Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City, also expressed caution.
"We've gone back and forth on how safe hormones are and this is just one study," she said. "It only looks at early menopause and it's only looking at hardening of the arteries. It didn't look at breast cancer, which is also a very big concern."
Before she could wholeheartedly encourage patients to take hormone replacement therapy in early menopause, Wu said she would like to see more studies on breast cancer. "We may not catch breast cancer in four years, though it may develop," she noted.
The new results reaffirm conclusions released in July by a coalition of 15 leading medical groups, including the North American Menopause Society, that hormone replacement therapy can be useful and safe for many women suffering from symptoms of menopause such as hot flashes and night sweats.
That statement said that hormone therapy is an acceptable choice for relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate-to-severe menopausal symptoms.
According to that statement, hormone replacement therapy increases the risk for blood clots in the legs and lungs, although this risk is rare in women 50 to 59 years old. Its use should be decided on a case-by-case basis, the statement authors said.
Breast cancer risk appears to increase when hormone replacement therapy is taken continuously for five years -- and possibly less. The risk declines when hormone replacement therapy is stopped, the coalition said.
The data and conclusions of research presented at medical meetings should be considered preliminary until published in a peer-reviewed medical journal.
The U.S. National Library of Medicine has more on hormone replacement therapy.
Posted: October 2012