A new study is showing that hormone therapy, estrogen in woman, could have saved nearly 50,000 lives a year.
For more than a decade, doctors have cautioned women about the risks associated with hormone replacement therapy. But those warnings may have put one group of women at increased risk of dying early, according to the latest study.
Researchers at Yale University say that nearly 50,000 women may have died prematurely after they stopped taking hormone replacement therapy to treat menopause symptoms, following a much-publicized 2002 study that revealed the treatment increased risk of heart disease and breast cancer.
The 2002 Women’s Health Initiative study, a 15 year investigation into the factors that contribute to the health of post menopausal women, was stopped three years early when a preliminary review of the data showed that women taking the combination of estrogen and progestin had a higher rate of breast cancer, heart disease and stroke than women taking a placebo.
The results stunned both the public and the medical community, since doctors had been prescribing the hormones not just to treat menopausal symptoms such as hot flashes, but for extended periods of time to protect women against heart disease.
Almost immediately, doctors and public health officials began shifting women away from such long term use of hormones, recommending that post-menopausal women restrict hormone use to the few months surrounding menopause to address the most intense symptoms.
In 2012, the United States Preventive Services Task Force confirmed the WHI trial’s findings, concluding after a review of 51 studies published since 2002 that the risks of HRT outweighed the benefits, which were limited to a reduced risk of fractures.
The WHI also continued to evaluate women who had had a hysterectomy, and therefore could take estrogen alone; women with an intact uterus are not advised to take estrogen without the protective effect of progesterone since estrogen is linked to a higher risk of uterine cancer.
In 2007, the WHI reported that women with a hysterectomy who took estrogen alone had fewer calcium-based plaques in their arteries, and therefore may have enjoyed some protection against heart disease.
This finding was supported by a 2011 study published in the Journal of the American Medical Association (JAMA) that found a slightly lower risk of breast cancer and no significantly increased risk of heart disease, blood clots, stroke or early death among women taking estrogen only compared to women with hysterectomies who took a placebo.
And as is the case with any scientific finding, not everyone in the medical community is convinced that the 50,000 women would have lived had they taken estrogen therapy. But most experts agree that the results should start a serious discussion about how to communicate public health messages so they are applied to the right populations in the correct way.
In the meantime, women should be asking their doctors about hormone therapy, and whether any version of the treatment is right for them. These discussions that could clear up confusion over what the latest data show about the risks and benefits of hormones. “The primary messenger for all messages ought to be the doctors to the patients,” says Dr. Georges Benjamin, executive director of the American Public Health Association. “The public hears a lot from trusted messengers that may not be knowledgeable.”