Healthy Skepticism Library item: 7957

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Publication type: news

Parker-pope T.
Hormone Therapy May Benefit Younger Women
Wall Street Journal 2007 Jan 26
www.wsj.com

Full text:

After years of debate about the safety of hormone therapy in menopause, a major medical group yesterday revised its position, stating that estrogen and progestin drugs may actually protect the hearts and bones of certain women.
The new guidelines from the North American Menopause Society, one of the leading scientific organizations that advises doctors about the care of women in midlife, are certain to spark more controversy. They come nearly five years after the Women’s Health Initiative, or WHI, a major government study, was halted early because older women participants had an unexpectedly high risk of heart attacks.
After examining the most recent data from the WHI and other studies, the North American Menopause Society panel acknowledged that the risks and benefits of hormones are likely different for younger women than for older women and that for younger women who use the drugs to treat symptoms, the benefits of short-term hormone use likely outweigh the risks.
For instance, women in the WHI who were 20 years past menopause had a 71% higher risk of heart attack if they used estrogen and progestin, but women close to menopause actually had an 11% lower risk of heart problems, according to data from the WHI study.

For most women, the menopause society’s new recommendations won’t change anything. Hormone therapy still is generally recommended only for the short-term treatment of menopause symptoms. However, the guidelines should be reassuring to women who use hormones to treat hot flashes and other menopause symptoms such as sleep disturbances and vaginal dryness.
“We’ve moved away from the overly simplistic conclusions that originally came out of the WHI,” says Wulf Utian, the North American Menopause Society’s executive director.
The WHI is the biggest ever study of menopause hormones, but the data have proved difficult to interpret and confusing to women. Part of the problem is that the average age of women in the study was 63. The typical user of menopause hormones is in her late 40s and early 50s, and many experts now believe the risk and benefits depend on a woman’s age and where she is in the menopausal transition. Even WHI investigators are still debating what conclusions can be drawn from the data for newly menopausal women.
Indeed, the revised position statement signals that the science of menopause hormones is still evolving and suggests that the verdict is still out on the risks and benefits of hormones for prevention of chronic diseases, particularly cardiovascular disease, diabetes and osteoporosis.
In addition, the statement notes that women shouldn’t take hormones to protect their hearts, but noted that the data show a “trend” toward lower heart risk for women who use hormones close to menopause. Also notable is the fact that the society stated that hormones are one option to prevent osteoporosis among certain women at high risk. In the past, the group had said nonsymptomatic women at risk for osteoporosis should always try other bone drugs first.
The statement also highlights the little-discussed issue of hormone drugs and diabetes. It cites data from the WHI that showed women who used estrogen and progestin were 21% less likely to develop diabetes and women who used estrogen only were 12% less likely to develop the disease. That translates to about 15 fewer cases for each 10,000 women a year.
The menopause society’s guidelines noted that breast-cancer risk with estrogen and progestin use increases after five years — to 4-to-6 additional cancers for each 10,000 women a year — but that the risk to an individual woman remains low. It noted that although the WHI showed estrogen-only users had a lower risk of breast cancer — eight fewer cases per 10,000 women a year — there is inadequate evidence to support estrogen use to prevent breast cancer.
Some health experts say they worry that the society’s statement is based on a still-unproven hypothesis about the timing of hormone use. “I think NAMS is getting out a little bit ahead of the evidence,” says Cindy Pearson, executive director of the Women’s Health Network, a group that for decades has lobbied for more evidence and research into major women’s health issues including hormone use.
Critics also note that the menopause society accepts money from pharmaceutical companies, including those that make hormone drugs such as Wyeth, whose Premarin and Prempro are the largest sellers. Several members of the panel disclosed that they work as consultants or receive research funding from drug makers, although some panel members, such as noted Harvard researcher JoAnn Manson, disclosed that they have no financial ties to drug companies.
“I think these guidelines help to put the recent evidence and the new studies into perspective for women,” says Dr.
Manson, who was also one of the lead investigators on the WHI. “I think the statement is likely to be reassuring to them that with short-term use the benefits of hormones are likely to outweigh the risks.”
The society noted that far more research is needed into the use of hormones by women close to menopause. A new study, the Kronos Early Estrogen Prevention Study (www.keepsstudy.org) is looking at the risks and benefits of hormone use in recently menopausal women. “There are many unanswered questions and many gaps in our understanding of the benefits and risks, so those research studies need to be supported,” Dr. Manson says.
Write to Tara Parker-Pope at tara.parker-pope@wsj.com