A few years ago, the use of hormone replacement therapy (HRT) looked like a
medical mess. For decades, women were told that HRT -- usually a combination of
estrogen and progestin -- was good for them during and after
menopause. Then the 2002 results of the
Women's Health Initiative study seemed to show just the opposite: hormone
replacement therapy actually had life-threatening risks such as
heart attacks, strokes, and cancer.
"Women felt betrayed," says Isaac Schiff, MD, chief of obstetrics and
gynecology at Massachusetts General Hospital in Boston. "They were calling
their doctors, saying, 'How could you put me on this drug which causes heart
attacks, strokes, and cancer?'"
It was the summer of 2002 when the news about hormone replacement therapy
(HRT) shook us to the core.
In what felt like a bomb dropped on all womankind, the U.S. federal
government halted the hormone trial of the Women's Health Initiative early – a
study designed to evaluate the risks and benefits of hormone replacement
therapy on disease prevention.
The reason: Not only had HRT failed to be the protective fountain of youth
doctors and women had long since believed, evidence was mounting...
Almost overnight, standard medical practice changed. Doctors stopped
prescribing hormone replacement therapy and 65% of women on HRT quit, according
But some experts say hormone replacement therapy may be coming back. All
along HRT remained an important treatment for menopause
symptoms like hot flashes. And now, a number of recent studies show that
hormone replacement therapy may have protective benefits for women who are
early in menopause.
"I think we swung too positive on hormone therapy in the past and then we
went too negative," says Schiff, who is also chair of the American College of
Obstetricians and Gynecologists Task Force on Hormone Therapy. "Now we're
trying to find a balance in between."
Hormone Replacement Therapy: The New Evidence
"We're definitely in a gray zone of uncertainty about hormone therapy," says
Jacques Rossouw, MD, project officer for the federal Women's Health Initiative
(WHI). "But when you're uncertain, you have to err on the side of safety."
While Rossouw concedes that new studies show some preventative benefit for
younger women, he says any potential benefit is very slight. And, he notes,
there is no evidence that any benefit would last if women kept taking hormones
as they got older.
But increasing numbers of researchers say there should be a place for
hormone replacement therapy as a preventive treatment for limited periods as it
may help prevent disease in younger women around the age of menopause.
"We have evidence that hormone therapy can prevent heart disease, hip
fractures, and osteoporosis, and that it cuts the risk of developing diabetes
by 30% in younger women," says Shelley R. Salpeter, MD, a clinical professor of
medicine at Stanford University's School of Medicine.
In one recent study, Salpeter and her colleagues found that HRT reduced the
number of heart attacks and cardiac deaths by 32% in women who were 60 or
younger (or women who had been through menopause less than 10 years ago). In
older women, hormone replacement therapy seemed to increase cardiac events in
the first year, and then began to reduce them after two years.
The 32% drop is significant, but perhaps not as dramatic as it sounds. In
hard numbers, Salpeter estimates that of women aged 50 to 59 who don't get
hormone replacement therapy, about 7 out of 4,800 will have a cardiac event in
one year. With HRT, 3 out of 4,800 will have a cardiac event.