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 Many women have been reluctant to use hormones for menopause
symptoms since 2002, when the federally funded Women’s Health
Initiative (WHI) study linked the treatments containing man-made
versions of the female hormones estrogen and progestin to an
increased risk of breast cancer, heart attacks and strokes.
The current study, however, looked at longer-term data from the WHI
study and found no increased risk of death from all causes, or from
cancer or cardiovascular issues in particular, associated with
hormone use.
“Women seeking treatment for distressing hot flashes, night sweats
or other menopausal symptoms may find the mortality results
reassuring,” said lead study author Dr. JoAnn Manson of Brigham and
Women's Hospital and Harvard Medical School in Boston.
Women go through menopause when they stop menstruating, typically
between ages 45 and 55. As the ovaries curb production of the
hormones estrogen and progesterone in the years leading up to
menopause and afterward, women can experience symptoms ranging from
irregular periods and vaginal dryness to mood swings and insomnia.
For the study, researchers looked at data on 27,347 women ages 50 to
79 who joined two WHI trials between 1993 and 1998 and were followed
through 2014. One trial tested estrogen alone against a placebo, or
dummy pill, while the other trial tested estrogen taken in
combination with progestin.
Women were 63 years old on average when they joined the trials and
had already gone through menopause. They took hormones or a placebo
for five to seven years and were followed for a total of 18 years
altogether.
During the study period, 7,489 women died.
Death rates were similar - at about 27 percent - among women who
took hormones and women who didn’t, researchers report in JAMA.
Younger women in the study appeared to have better survival odds
with HRT. Over the initial five to seven years when women were
randomly assigned to take hormones or a placebo, death rates were
about 30 percent lower among women aged 50 to 59 when they took HRT
than when they didn’t.
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For women who started hormones in their 60s or 70s, however, there
wasn’t a meaningful difference in death rates according to whether
they got the treatment or a placebo during the initial years of the
study.
After 18 years, including both the treatment period and a decade or
more of follow-up, women’s age when they joined the study no longer
appeared to significantly influence death rates.
One limitation of the study is that the WHI didn’t look at different
dosages of hormone pills, and the findings may be different for
other dosages or different types of therapy such as gels or creams
or skin patches.
Still, the current study should ease concerns raised by earlier
results from the WHI trials that an increased risk of breast cancer
or heart attacks might translate into higher long-term mortality
rates, said Dr. Melissa McNeil, author of an accompanying editorial
and a women’s health researcher at the University of Pittsburgh.
Taking a combination of estrogen and progestin is associated with an
increased risk of breast cancer, but advances in screening and
treatment since the WHI started now mean these tumors are unlikely
to be fatal, McNeil said by email.
With additional years of follow-up, it also appears that the
increased heart attack risk associated with HRT in the initial
results from the WHI trials is limited to older women, McNeil added.
“Hormone therapy has been in and out of favor - first it was good
for all menopausal women, then it was dangerous for all women,”
McNeil said. “The take-home message now is that for the right
patient, hormone therapy is safe and effective.”
SOURCE: http://bit.ly/2jkqUFE and http://bit.ly/2jo0piX JAMA, online
September 12, 2017.
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