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Hormone Therapy May Benefit Some Women's Hearts

Hormone Replacement for Younger Women continued...

“When the results from the WHI came, in 2002, everything was turned upside down,” says Schierbeck, referring to the swift impact of that study, which caused millions of women to stop taking their hormones.

But Schierbeck and others think the results of the WHI have unfairly applied to younger women.

“The main problem with the WHI was that the women were so much older. They were, on average 63 years old when they were included in that study,” she says.

“It doesn’t make sense to treat menopausal symptoms when you are more than 10 years away from menopause. By that time, your entire biology has changed. It’s completely unnatural.”

Last week, U.S. researchers announced preliminary results from the smaller Kronos Early Estrogen Prevention Study, showing that younger women could get relief from some of the worst symptoms of menopause with little short-term risk. That study has only followed women for about four years, so it couldn’t shed light on what might happen to cancer risks or dementia as the women got older.

Findings Come With Caveats

While the new study seems to bolster the timing hypothesis, experts caution that it has some important limitations.

  • The original intent of the trial was to see if HRT could help with bone health. Questions about cancers, strokes, heart disease risks, and deaths were asked after all the data for the study had already been gathered. That can sometimes skew research results.
  • Women and their doctors knew whether or not they were taking hormones. That can bias the results.
  • With just over 1,000 women, the study was relatively small. In contrast, the WHI trials of HRT included more than 27,000 women.
  • The study was partly funded by drug companies that make HRT and thus have a financial interest in the outcome of the study.

In addition, researchers mixed two different groups of women, those with and without a uterus. That’s important because women who’ve had their uterus surgically removed are prescribed a different kind of HRT than women who still have a uterus. They take estrogen alone.

Many studies, including the WHI, have shown that taking estrogen alone is safer for younger women and may even offer some protection against heart disease and breast cancer, compared to when it is balanced with progesterone. Women who still have their uterus have to take both because using estrogen by itself raises the risk for endometrial cancer.

Mixing both groups of women in the study may have muddied the results, says Rowan T. Chlebowski, MD, PhD, chief of medical oncology at the David Geffen School of Medicine at UCLA.

For women who still had their uterus, the study tested an estrogen-progesterone combination that isn’t commonly used in the U.S., Chlebowski says, so it’s unclear whether the results would apply to women in this country.

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