Article posted January 15, 2008.
I write this piece because of the unnecessary suffering I, as a gynecologist, see in my practice every day. It involves women and their doctors who are terrified to use hormones in menopause especially since the report of the Women’s Health Initiative (WHI) came out in 2002 with its dramatic negative findings.
There are, or there should be, many red faces at the National Institute of Health (NIH) these days as they are coming to realize that their initial blanket condemnation of hormone replacement therapy (HRT) after menopause failed to interpret the results of the WHI correctly. The error was to lump together women from 50 to 79 years of age together without appreciating that in the younger women, the results favored HRT.
Now as they have been able to analyze the results by age group, they are saying that women within 10 years of menopause who start taking HRT have NO negative consequences, particularly with breast cancer and heart disease. It is mainly those who started taking the hormones 20 years after menopause that did not benefit.
They are now saying, and hopefully this positive news will filter into the news media, that younger women at or around menopause can enjoy not only feeling good and free from menopause side effects (hot flashes, night sweats, insomnia, moodiness, irritability, anxiety, depression, mental confusion, loss of libido, and reduced sexual response), but that they can take HRT for at least 10 years with the benefits far outweighing any risks.
There is no need for women to suffer the often-debilitating effects of menopause. There is no need to fear estrogen. Even the WHI found that women on estrogen only (those who had had hysterectomies) had less breast cancer and heart disease at the end of the seven years of the study than those women who took placebo.
This does not come as a surprise. There are hundreds of studies in the medical literature showing the benefits of estrogen on the heart and blood vessels, and as heart disease kills one out of two women it is the most important health issue for aging women.
In contrast, breast cancer kills about one in 28 women. More than 70 percent of breast cancer patients survive and indeed the largest cancer survivor group in the U.S. is breast cancer survivors.
The fear of the association of estrogen and breast cancer is greatly exaggerated. There are many studies which show a positive effect of estrogen on the breasts which is protective for breast cancer. So the finding of the WHI of less breast cancer in women on estrogen alone conforms to previous findings.
Now here is some more good news! Estrogen is available in patches and gels that allow for absorption through the skin rather than orally. This offers further health benefits, including the avoidance of venous blood clots.
Also, for those women who still have their uterus and therefore need to take progesterone to balance the effect of estrogen on the uterine lining, there is now a pure progesterone product that appears to be more beneficial to the heart and breast than the older product used in the past and in the WHI study.
What about the claim of the WHI that HRT caused more dementia? We now know that this was seen only in the women over the age of 75 who started HRT for the first time at that age! There are studies that show that women who took HRT in menopause had less Alzheimer's Disease in old age than women who didn't.
How long should women take HRT? The evidence is now convincing that at least till the age of 60 benefits much outweigh risks. From 60-70 there seems little cause for concern particularly if all the usual breast exams and mammograms are carried out. Over the age of 70, a woman should consult with her gynecologist who would need to take all health and lifestyle issues into account. The sad fact is that no study has ever been done to answer this question.
They advise that women should “take as little HRT for as short a time as possible” has no study to support it and is no longer the position of the North American Menopause Society.
If you stopped your HRT or haven’t started because of unjustified fear it is time to get back to your gynecologist for a serious discussion.