No problem getting the word out this year. It seemed as if every month researchers released more bad news. New data showed that hormone therapy increased the risk of dementia, and that women who took hormones were more likely to have more advanced breast cancers. Research also showed that the heart-disease risk increased 80 percent during the first year of use.
The scary headlines are bewildering to a generation of women who grew up thinking hormone therapy was virtually a fountain of youth. Many simply threw out their pills. In the four months after the July 2002 publication of the NIH’s Women’s Health Initiative study, about a third of women on estrogen-plus-progesterone products stopped taking them, according to research by a company called Express Scripts, which studies prescription data. A year later only 15 percent of the quitters had started taking hormones again. The decline continued this year. In March, Express Scripts found that an additional 26 percent of women who had originally decided to stick with hormone therapy had later dropped it. And everybody wondered: how could the doctors get it so wrong?
The simple answer is that doctors originally decided hormone therapy was safe because they’d seen positive results in their patients who began treatment at the start of menopause. Based on observational studies of these first patients, doctors began to think in the late 1980s that besides easing hot flashes, hormone therapy prevented all kinds of chronic diseases, says Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital in Boston. Because women on hormone therapy appeared to have fewer cardiovascular problems, doctors concluded that hormones prevented heart disease. “It was a runaway train,” Schiff says. “We lost the focus about what estrogens are really helpful for. And it’s for symptom relief.”
What they didn’t realize is that the patients who took hormones were healthier than the general population–and significantly healthier than the women in the WHI study. In the first major observational study, the average body-mass index of the women subjects was 24, indicating a healthy weight; in the WHI study it was 28, indicating an unhealthy weight. The women in the first studies were also younger–and therefore less at risk for heart attacks–when they started taking hormones (about 51, the average age for the start of menopause).
Some critics blame the pharmaceutical industry. Doctors “let themselves be very manipulated by the drug companies,” says Barbara Seaman, author of “The Greatest Experiment Ever Performed on Women,” a history of hormone therapy. Seaman contends that doctors who accept pharmaceutical grant money or perks might have been more likely to overlook complications. Most doctors, of course, say that they were acting on the best available scientific evidence.
Over the next two years the NIH will continue to study the long-term effects of taking estrogen without progesterone; doctors speculate that estrogen alone might be safer. Meanwhile, one result of the furor is already clear: women and their doctors will no longer reach automatically for hormones at the first hot flash. “Pharmacotherapy is not your first choice,” says Wulf Utian, executive director of the North American Menopause Society. “If she’s smoking and she’s overweight, her hot flashes may even decrease if she stops smoking or watches her diet and exercises.”
As for heart attacks–which prompted so many women to start hormone therapy–WHI investigator JoAnn Manson of Harvard says that 80 percent of the risk can be eliminated through a healthy lifestyle. Others have tried natural remedies like black cohosh. Still, despite all the negative publicity, doctors continue to prescribe limited HRT (no more than three years) for patients who’ve tried other remedies and still suffer from debilitating hot flashes or other menopausal symptoms. For these patients, relief is worth the risk.
title: “Relief That May Be Too Risky” ShowToc: true date: “2023-01-13” author: “Edward Bucher”
No problem getting the word out this year. It seemed like every month, researchers released more bad news. New data showed that hormone therapy increased the risk of dementia, and that women who took hormones were more likely to have larger and more advanced breast cancers. Research also showed that the heart-disease risk increased 80 percent during the first year of use.
The scary headlines are bewildering to a generation of women who grew up thinking hormone therapy was virtually a fountain of youth. Many simply threw out their pills. In the four months following the July 2002 publication of the NIH’s Women’s Health Initiative study, about a third of women on estrogen-plus-progesterone products stopped taking them, according to research by a company called Express Scripts, which studies prescription data. A year later only 15 percent of the quitters had started taking hormones again. The decline continued this year. In March, Express Scripts found that an additional 26 percent of women who had originally decided to stick with hormone therapy had later dropped it. And everybody wondered: how could the doctors get it so wrong?
The simple answer is that doctors originally decided hormone therapy was safe because they’d seen positive results in their patients who began treatment at the start of menopause. Based on observational studies of these first patients, doctors began to think in the late 1980s that besides easing hot flashes, hormone therapy prevented all kinds of chronic diseases, says Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital in Boston and chair of the American College of Obstetricians and Gynecologists’ task force on hormone therapy. Because women on hormone therapy appeared to have fewer cardiovascular problems, doctors concluded that hormones prevented heart disease. “It was a runaway train,” Schiff says. “We lost the focus about what estrogens are really helpful for. And it’s for symptom relief.”
What they didn’t realize is that the patients who took hormones were healthier than the general population–and significantly healthier than the women in the WHI study. In the first major observational study, the average body mass index of the women subjects was 24, indicating a healthy weight; in the WHI study, it was 28, indicating an unhealthy weight. The women in the first studies were also younger–and therefore less at risk for heart attacks–when they started taking hormones (about 51, the average age for the start of menopause).
Some critics blame the pharmaceutical industry. Doctors “let themselves be very manipulated by the drug companies,” says Barbara Seaman, author of “The Greatest Experiment Ever Performed on Women,” a history of hormone therapy. Seaman contends that doctors who accept pharmaceutical grant money or perks, like trips to exotic places for conferences, might have been more likely to overlook complications from the drug. Most doctors, of course, deny that claim and say that they were acting on the best available scientific evidence.
Over the next two years the NIH will continue to study the long-term effects of taking estrogen without progesterone; doctors speculate that estrogen alone might be safer. Meanwhile, one result of the furor is already clear: women and their doctors will no longer reach automatically for hormones at the first hot flash. “Pharmacotherapy is not your first choice,” says Wulf Utian, executive director of the North American Menopause Society and a gynecologist at the Cleveland Clinic. “If she’s smoking and she’s overweight, her hot flashes may even decrease if she stops smoking or watches her diet and exercises.”
As for heart attacks–which prompted so many women to start hormone therapy–WHI investigator JoAnn Manson of Harvard says that 80 percent of the risk can be eliminated through a healthy lifestyle. Others have tried natural remedies like black cohosh. Still, despite all the negative publicity, doctors continue to prescribe limited HRT (no more than three years) for patients who’ve tried other remedies and still suffer from debilitating hot flashes or other menopausal symptoms. For these patients, relief is worth the risk.
