Hormone Therapy: Heartening News
Estrogen Doesn't Harm, Seems to Protect Hearts of 50+ Women
Hormone Therapy: How Long?
Hormone therapy with any of the several available estrogen/progesterone or
estrogen-only products is currently intended only for relief of moderate to
severe menopausal symptoms. Current recommendations call for the products to be
used at the lowest effective dose, for the shortest possible time.
"There are some risks of hormone therapy, and that is why it is
important for women not use these hormones expressly for reduction of heart
disease risk," Manson says. "There is increased risk of blood clots in
the legs, and of breast cancer. Now we are treating women only for moderate to
severe menopausal symptoms, and only for three years. In that scenario --
recently menopausal woman in good cardiologic health with severe menopausal
symptoms -- for them it is much more likely the benefits will outweigh the
Manson now recommends that women use hormone therapy for no more
than five years. Hodis and Warren disagree, noting that the long-term
benefits of hormone therapy disappear when treatment stops.
"In clinical trials, the longer the women took hormones, the greater the
benefit. And other data show that when women stop hormones, the heart disease
benefit goes away," Hodis says. "Personally, I think that if there is
going to be protection, this is something that has to be continued. ... I think
you can have even greater adverse effects from stopping estrogen than from
"The question is, when should we stop hormones? We will never know for
sure," Warren says. "But the bulk of the evidence is it does protect
the heart. ... I feel reassured. I can tell patients, 'Look, if you are worried
about your heart and have been on this since menopause, I am not worried any
more.' I feel if you don't need a drug, you shouldn't be on it. But there is a
downside to stopping estrogen, and what this study implies is the heart disease
will accelerate, and we know from other studies you will lose bone."
But Stanford University professor Marcia Stefanick, PhD, chairwoman of the
national steering committee for the WHI, warns that the effect of estrogen on
just one risk factor for heart disease does not prove hormone therapy protects
women's hearts. And estrogen carries other risks, too, she says.
"We have to keep in mind that heart disease is only one potential health
risk of hormone therapy," Stefanick says in a news release. "When women
are thinking about taking estrogen, they should consider the overall
risk-benefit balance, which includes an increased risk of stroke and blood
clots, regardless of age."
More Hormone Therapy Answers to Come
Manson says many of the questions Warren and Hodis raise will be answered by
the Kronos Early Estrogen Prevention Study (KEEPS). The study -- which is now
recruiting patients -- is looking specifically at the question of whether
hormone therapy can prevent plaque buildup in the arteries.
The study will compare oral estrogen pills to transdermal estrogen patches.
Women receiving estrogen will also take bioidentical human progestin, which is
considered safer than previous progesterone products.
Women can learn more about the study -- and volunteer to participate -- via
the KEEPS web site, keepstudy.org.
- Are you considering
estrogen therapy? Join this and other discussions on WebMD’s Menopause
Support Group board.