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HRT: Revisiting the Hormone Decision

It's been 5 years since studies proclaimed hormone replacement therapy a danger for women. WebMD investigates today’s changes and tells you what you need to know to make the HRT decision.

Why Age Matters continued...

"What we discovered is that if a woman is between the ages of 50 and 55 when she starts taking hormones, or if she begins HRT less than 10 years after she started menopause, she has less heart disease and less death from any cause, compared to the placebo group," says Goldstein.

Those results were published in April 2007 in the Journal of the American Medical Association – and then again reinforced by similar research published in The New England Journal of Medicine the following June.

Here researchers focused on younger women who had a hysterectomy, and took estrogen alone. These results suggested that in these women HRT may also have protective effects on the heart.   

"Women who were in their 50s in the estrogen-alone trial tended to have less coronary artery calcium if they received estrogen compared to placebo. And coronary artery calcium is ... a strong predictor of future risk of coronary heart disease, so these results lend support to the theory that estrogen may slow early stages of arteriosclerosis," says researcher JoAnn Manson, MD, DrPH, chief of preventive medicine, Brigham and Women's Hospital, and professor of medicine and women's health, Harvard Medical School, Boston.

Unfortunately, Goldstein says neither message seems to have been relayed to women or even their doctors, and as a result many women are suffering unnecessarily, afraid to use hormones to quell menopause symptoms in order to protect their heart.

"We have strong evidence to show that if it is less than 10 years since you started menopause, using HRT on a short-term basis is not likely to harm you, and it can help you; you shouldn't be afraid," he says.

Cardiologist Nieca Goldberg, MD, agrees.  "Women can sort of relax a little -- that when they’re younger and need to go on hormone therapy because of their symptoms, that this may not be detrimental to their heart," she says.

Those at risk for stroke, however, may not share this same sense of relief. In the same April 2007 JAMA study, researchers found the risk of stroke increased in HRT users by some 32% -- and that age or years since menopause didn't matter.

HRT and Breast Cancer

While the impact of HRT on the heart may seem less ominous today than in 2002, links to breast cancer are less clear -- and some say less encouraging. 

Many experts say that more than coincidence was at work when, in the years following the WHI announcement, women stopped taking hormones en masse -- and the incidence of breast cancer subsequently declined.

"A drop in hormone use may not have been the sole reason we saw fewer breast cancers, but I am certainly convinced it played a significant role," says Julia Smith, MD, director of the Lynne Cohen Breast Cancer Preventive Care Program at the NYU Medical Center in New York City.

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