HORMONE REPLACEMENT THERAPY:
Do the Risks Outweigh the Benefits?

A major study on hormone replacement therapy has concluded that the long-term use of estrogen plus progestin poses a more significant health risk than was previously thought. If you are one of the millions of women taking hormone replacement therapy, should you stop using it?

Hormone replacement therapy (HRT), a treatment that combines estrogen and progestin, has been used in the short term to reduce the unpleasant physical and psychological symptoms of menopause. The long-term use of HRT has been based on previous studies that suggested it would prevent heart disease and osteoporosis. However, results from recent, well-designed Women's Health Initiative Study of one type of HRT suggests that the long-term use of estrogen plus progestin significantly increases women's risks of breast cancer, strokes, and heart attacks.

Findings from the Women's Health Initiative Study
Since the combined hormone replacement therapy (HRT) arm of the Women's Health Initiative (WHI) was discontinued, clinicians have been challenged to offer menopausal women new options for reducing their risk of cardiovascular disease and osteoporosis and for relieving symptoms associated with menopause. Many women who'd been taking HRT abruptly discontinued it and now they need alternatives to ensure that they don't reverse any gains they may have made while taking HRT.

Hormone replacement therapy had been viewed by many as a magic potion for the aging woman. It provided menopausal symptom relief, managed osteoporosis, and improved serum lipid levels. Many clinicians were confident that the WHI would validate HRT as a comprehensive strategy for promoting health in menopausal women.

It didn't. Instead, the WHI raised more questions about the safety of HRT. The National Institutes of Health stopped the trial because researchers detected a greater risk of breast cancer, heart attacks, strokes, and thromboembolism among women taking HRT. Nevertheless, many women are now uncomfortable with the idea of HRT.

Another part of WHI released in 2003 challenged the nation that HRT may decrease a woman's cognitive functioning and may pose a risk of developing dementia. (Findings from the WHI Memory study)

Benefits of Long-term HRT
The study also found some benefits of HRT. Women in the estrogen plus progestin group compared to those in the placebo group experienced the following benefits:

• 37% fewer cases of colorectal cancer
• 33% fewer hip fractures
• 24% fewer total fractures

Although these benefits were significant, on balance, more women were harmed by HRT than were helped. The results of the study have been published online by the Journal of the American Medical Association (JAMA) and in the journal's July 17, 2002 issue.

What do the study results mean?
Many experts are recommending women who are currently taking estrogen plus progestin should talk with their doctor to see if they should continue taking it. If they are taking this hormone combination for the short-term relief of symptoms, it may be reasonable to continue since the benefits are likely to outweigh the risks. Longer term use for disease prevention must be evaluated.

Recommendations
The National Institutes of Health encourages women taking estrogen plus progestin not to panic, but rather to consider the following recommendations:

Talk to your doctor about whether or not you should continue taking estrogen plus progestin.
If you are 50 or older, get screened for breast cancer with mammography every 1 to 2 years. It may be prudent to begin mammography screening in your 40s, though the benefits of this have not been clearly established.
Do not take estrogen plus progestin to lower your risk of heart disease and its complications.
Talk to your doctor about other methods (medications and lifestyle changes) of preventing heart attack, stroke, and osteoporosis. Other medications and lifestyle measures have been shown to reduce the risk of these conditions.
Remember that if you have been taking HRT, your individual risk is still relatively low. There is no need to panic.