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MenoPause Blog

Good News on Hormone Therapy

by JoAnn Pinkerton | Sep 13, 2017

We're pleased to have a guest post from Dr. Marla Shapiro.

Marla Shapiro

Marla Shapiro, CM, MDCM, CCFP, MHSC, FRCPC, FCFP, NCMP 

NAMS President

For many women with severe hot flashes, night sweats, and other disruptive symptoms of menopause, there has been continued concern about the long-term effects of using hormone therapy (HT) for relief. In 2002, the Women’s Health Initiative (WHI) trials tested two of the most common formulations of HT—an estrogen used alone and an estrogen combined with a progestin for women with a uterus—to assess the benefits and risks of HT taken for symptom relief by predominantly healthy, postmenopausal women. The clinical trials and observational study were designed to test the effects of postmenopausal HT, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer.

The initial trial results were alarming because they reported an increase in heart disease, stroke, and breast cancer in the study population. Since that time, researchers have looked at the data by age group, and in younger menopausal women aged between 50 and 60 years or within 10 years of menopause, have not seen many of these initial concerns.

A new study led by investigators at Brigham and Women’s Hospital in Boston has looked at the long-term death rates from all causes as well as the rates of death from specific causes. The new findings are very reassuring. In the overall study of women aged 50 to 79 years, researchers found no increase or decrease in total mortality or death from cardiovascular disease, cancer, or other major illnesses. Mortality or death rates are the ultimate bottom line when assessing the net effect of a medication on serious and life-threatening health outcomes.

Mortality or death outcomes were found to be more favorable in younger women who received HT compared with older women who also received therapy. The death rates in the women aged 50 to 59 years tended to be approximately 30% lower in women who received HT compared with women of the same age who received a placebo. Even in women who initiated HT in their 60s and 70s, no effect on death rate was observed.

In addition, over the extended follow-up period (18 years since the study started), overall deaths from cardiovascular disease and cancer had neither increased nor decreased in women who received HT. The researchers also found that deaths from Alzheimer disease and other forms of dementia were significantly lower with estrogen alone than with placebo during the 18 years of follow-up, and use of estrogen plus progestin was not associated with dementia mortality.

It should be noted that the WHI HT trials addressed the benefits and risks of the most common formulations of HT used at the start of the study and available at that time. Since then, lower doses, different formulations, and new administration methods (skin patches, gels, sprays) of HT have become available and are increasingly common. Additional research on the long-term benefits and risks of these newer treatments is needed, but it is very reassuring to see no increase in all-cause death rates related to the HT used in the WHI.

For more details on the new study, please watch this informational video.

 



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JoAnn V. Pinkerton, MD, NCMP
Executive Director

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