For decades women were told that hormone replacement therapy was good for them. Estrogen and progestin were supposed to ease symptoms of menopause, build strong bones and reduce the risk of heart attacks and strokes. Over 30 billion doses of Premarin, the leading brand of estrogen, have been dispensed since 1942.
Then along came the Women’s Health Initiative. Starting in 1991 roughly 30,000 postmenopausal women were given either Premarin or placebo. (Those who had not had hysterectomies got Provera, a form of progesterone, in addition to their Premarin or placebo, to protect the uterine lining from endometrial cancer.)
In 2002 the study was brought to a premature close because women taking estrogen were more likely to develop heart disease, strokes and breast cancer. (The differences were not large, but they were statistically significant.) In the years following the study, women reduced their use of hormone replacement therapy and breast cancer diagnoses fell.
Now, a new study suggests that when HRT is initiated close to menopause, it might not increase heart disease. The researchers recruited 727 women between the ages of 42 and 58. They were randomized to oral estrogen, estrogen patch or placebo and followed for four years. Those with an intact uterus also received progesterone. There was no difference between the groups in arterial plaque or coronary calcium, markers for heart disease. The study did not measure actual heart attacks, strokes or breast cancer, so it is hard to compare the results to the Women’s Health Initiative findings.
[Annals of Internal Medicine, July 28, 2014]
The People’s Pharmacy perspective on this study is cautious. It was neither large enough nor long enough to be able to pick up actual strokes or heart attacks, and we don’t know how sensitive the markers of cardiovascular risk that were used really are. The scientists relied primarily on images to show the thickness of the carotid artery lining; although this has been suggested as a way to judge susceptibility to heart attack or stroke, since the carotid artery runs up the neck to the brain, it is not universally accepted. We suspect the researchers had hoped to demonstrate a difference among the groups, but since there weren’t any, we still don’t think postmenopausal estrogen should be held up as help for the heart.
Hormone replacement therapy is the gold standard for treating hot flashes and night sweats, but without other advantages, women may want to limit their use of hormones to the lowest dose for the shortest time they can stand. (The medications used in the study were Premarin and Climara.)
For other approaches to controlling hot flashes, women may wish to consult our Guide to Menopause.
