The headlines this week reassured millions of women that hormone replacement therapy poses no risk to the heart. This contradicts a prior study that found HRT increased the risk for heart attacks and strokes. What gives?
Women have every right to be confused and frustrated. Here are this week’s headlines with a reassuring introduction:
“Hormone-Replacement Therapy Seems Safe, Study Finds” Wall Street Journal, July 28, 2014
“Hormone-replacement therapy started soon after menopause seems safe and lowers some markers of heart-disease risk while significantly reducing hot flashes, according to a multicenter trial published in the Annals of Internal Medicine on Monday.”
“Study: Hormone Replacement Therapy Safe for Most Women” FOX 31, Denver, July 29, 2014
“Hormone replacement therapy, or HRT, can be a woman’s best friend when she is going through menopause.
The drugs can take away hot flashes and other symptoms. In the past, HRT was said to be dangerous for many women, but a new study says it is safer than once thought.”
“Hormone Therapy Safe For Women’s Hearts When Taken Before Menopause” Headlines & Global News, July 29, 2014
The reporter went on to say:
“A new study found hormone replacement therapy does not pose harm to the heart when taken during menopause onset, contradicting earlier studies stating these kinds of drugs could be detrimental to women’s health.”
The implications were that women should no longer worry about HRT, especially when it comes to cardiovascular risks. It was as if the lifeguards shouted: “OK everyone, it’s safe to go back in the water. You can resume taking hormones to ease hot flashes without hesitation.”
The People’s Pharmacy Analysis
There are few treatments in modern medicine that have generated as much controversy, confusion and emotional turmoil than hormone replacement therapy. Since Premarin (estrogen prepared from purified pregnant mare’s urine) was approved in the early 1940s, the drug has been hugely popular. At one point the company bragged that more than 30 billion doses had been dispensed. That was a long time ago, so the number is doubtless much higher now, especially if you include the combination product Prempro (Premarin plus synthetic progestin).
Physicians used to encourage their women patients to take hormones not only to ease symptoms of menopause (hot flashes and night sweats) but also to relieve anxiety, slow the aging process, build strong bones and protect hearts and brains. Some experts even suggested that estrogen might lower the risk of certain cancers, including breast cancer.
Then along came a huge government-sponsored study called the Women’s Health Initiative (WHI). Beginning in 1991 nearly 30,000 postmenopausal women (ages 50 to 79) were recruited to get either Premarin or placebo. Women who had not undergone hysterectomies also received synthetic progesterone to protect the uterus from endometrial cancer.
In 2002 the study was brought to a sudden stop because the preliminary results showed that women taking hormones were more likely to develop heart disease, strokes, blood clots and breast cancer. The results came as a huge shock to the medical community. Millions of women were outraged. Almost overnight they were told that hormones were harming rather than helping them.
Many physicians felt betrayed, just like their patients. But some resisted the WHI findings and criticized the study, despite its large size and long-term follow-up. In recent years some researchers described HRT concerns as “mass fear” and “hysteria.” They insisted that the benefits of hormones far outweighed the risks of breast cancer or heart attacks.
Fast forward to this week. The study in question was published in the Annals of Internal Medicine (online, July 29, 2014). Unlike the WHI study, which involved tens of thousands of postmenopausal women followed for more than five years, this study involved 727 younger women (ages 42 to 58).
The goal was to prove that hormones would reduce the risk of cardiovascular disease by preventing fatty plaque formation and calcium buildup in coronary arteries. There were 230 women who received oral estrogen (Premarin), 222 who got an estrogen patch (Climara) and 275 women who were randomized to placebo. The study lasted four years. At the end of the trial there was no reduction in atherosclerosis, the primary point of the study.
So, a study that was aimed to resurrect hormone therapy as a valuable prevention against heart disease failed. Instead of admitting that the hypothesis (giving hormones to younger women would be a boon rather than a boondoggle), the investigators tried to turn the findings into lemonade rather than lemons. That is why you saw such positive headlines at the top of this article. The spinmasters turned disappointment into a positive message that hormones were safe for the heart.
What they did not mention was that the new trial did not actually look for heart attacks or strokes the way the WHI study did. Just because there was no increase in atherosclerosis in a relatively small number of women does not clear hormone therapy in our minds. Because the Women’s Health Initiative was so much bigger, lasted so much longer and looked at outcomes that women really care about (heart attacks, strokes, blood clots, dementia and breast cancer), there is no way to fairly compare the two studies.
The Bottom Line on Hormone Replacement Therapy
Be wary of misleading headlines and quick analyses of complicated topics like hormone replacement therapy. To learn more about other ways to deal with hot flashes, we suggest Graedons’ Guide to Menopause. It will provide you a much more in-depth understanding of the results of the Women’s Health Initiative and other strategies for coping with menopausal symptoms.
Share your own experience with hormone replacement therapy below and how you have dealt with hot flashes and night sweats.