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BOSTON, Aug. 6, 2003
Two medical studies released Wednesday provided
more damning evidence that giving female hormones to older
women does little to improve their health and may in fact harm
it.
The studies found that the treatments do not protect
women from heart disease, as doctors once believed, and one of
the
studies
found that giving hormones to women actually increases their
risk of heart attack.
Both studies appeared in the New England
Journal of Medicine, which published a separate piece of research
earlier this year suggesting the health risks of estrogen and
progestin treatments for older women outweigh the benefits.
In one study in this week’s Journal,
a research team led by JoAnn Manson of Brigham and Women’s
Hospital in Boston found that women taking estrogen and progestin
increase their risk of a heart attack by 81 percent in the first
year.
The findings, the researchers said, mean
that most women who are taking the hormones should stop, and
those who have reached menopause should not start.
“Overall, the risk of treatment outweighed
the benefits during 5.6 years of treatment,” they concluded
in their study.
Although hormone supplements may reduce the
risk of hip fracture and colorectal cancer, they increase the
likelihood of stroke by 41 percent, the longer-term risk of a
heart attack by 29 percent, and the chance of breast cancer by
26 percent. The only remaining reason for prescribing the treatment
is to relieve the symptoms of menopause, the Manson team said.
They ended their study of 16,608 women early
once the dangers of hormone treatments became apparent.
Key
points
For millions of women, the question of whether
to take hormone replacement therapy after menopause just got
more confusing.
All the answers aren't in yet, but new findings suggest many
of the 6 million American women who use estrogen and progestin
should quit.
* If you're using the hormone combination in hopes it will
protect your heart -- quit. Contrary to once-popular belief,
the pills
can actually harm the hearts of previously healthy women,
the study found.
* If you're using HRT to prevent osteoporosis, at some point
you should consider taking some of the other medications
which have not been shown to increase the risk for breast
cancer,
such as raloxifene.
* If a woman has severe hot flashes and finds relief with
HRT but now wants to stop, she ought to wean herself slowly
over
time -- it may take up to six months. But if one stops the
supplements abruptly, the hot flashes may come back severely.
* These warnings don't apply to the 8 million more American
women who use estrogen alone - a therapy restricted to those
who've
had hysterectomies because estrogen causes uterine cancer
unless balanced by progestin. The NIH is letting a second,
smaller
study of those women continue for now, saying the risks and
benefits
remain unclear.
* The National Institutes of Health urges women taking hormones
to talk with their doctors about what to do.
That produced a “nearly unshakable
belief in the benefits of hormone therapy” in the absence
of a real test of the treatment, said David Herrington and
Timothy Howard of the Wake Forest University School of Medicine
in Winston-Salem, North Carolina.
Even when studies, beginning in 1998, revealed
there was no benefit, the belief was so ingrained the findings
were heavily criticized and dismissed, Herrington and Howard
wrote in an analysis in the Journal.
They said this case illustrates that animal
tests and observational studies are no substitute for studies
that use placebos and include large numbers of people.
© 2003 Reuters Limited
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Menopause