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Risks of Hormones in Early Menopause Challenged

Weighing Benefits and Risks continued...

Hormone therapy had a mixed effect on some measures of heart health. Hormones didn’t raise blood pressure, as had been seen in other studies. Women taking hormones also had small, positive changes in their cholesterol, with an increase in good cholesterol, HDL, and a decrease in bad LDL levels, compared to women on the placebo. But hormones also raised blood fats called triglycerides and C-reactive protein, an indicator of inflammation. Both markers are linked to an increased risk of heart disease.

Nearly 700 women agreed to participate in the part of the study that looked at mental function. They took tests at the start of the study and at 18, 36, and 48 months, designed to measure mood and memory.

“We found symptoms related to depression were significantly improved for women who got the oral form of estrogen. The skin patch [on the] arm didn’t show benefits or harm for mood,” Asthana says.

Estrogen pills, but not patches, seemed to improve anxiety and tension compared to a placebo, he says.

Women on hormones in the KEEPS study showed no memory loss over the course of the study. That was a relief, Asthana says, because the WHI found that women taking hormones were at higher risk for dementia than those who did not take them.

But he acknowledges that four years may not be enough time to measure meaningful changes to memory.

Safety Issues

The women in the KEEPS study were also more than a decade younger than women in the WHI. Hormones may affect the brain in ways that may only show up as women age, says Rowan T. Chlebowski, MD, PhD, a medical oncologist at the David Geffen School of Medicine at UCLA.

Chlebowski has been a lead researcher in the WHI. He was not involved in the current study.

“The big thing for me, as a medical oncologist, is that it doesn’t address the safety issue of cancer,” he says. “Estrogen plus progestin in the WHI significantly increased the risk for breast and lung cancer, the two leading causes of cancer death in women.”

“In a three- or four-year study, you really can’t say anything about breast cancer safety,” Chlebowski says.

Researchers acknowledge that their study was too small to show significant differences in the numbers of serious side effects like heart attacks, strokes, and cancers between women who took hormones and those who did not.

But they say it should reassure women who need to take hormones for a short time.

“The KEEPS study shows there are a lot of benefits of starting hormone therapy,” Asthana says. “The findings suggest that the risk benefit ratio is shifted a bit more toward benefits. Until now, it was the risk that was dominating.”

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