Did Avoidance of Hormone Therapy Harm Certain Women?
For older women without a uterus, estrogen may save lives, researchers say
They found that use of estrogen-only therapy in U.S. women aged 50 to 59 declined nearly 79 percent between 2001 and 2011.
During that time, at least 18,000 excess deaths occurred because of estrogen avoidance and possibly more than 91,000, depending on the calculations used, Sarrel's team said. For this reason, their best estimate -- of about 50,000 deaths -- may be conservative, said Sarrel.
While the study found an association between a decline in hormone therapy and deaths among women who have had a hysterectomy, it did not prove the existence of a cause-and-effect relationship.
As experts have analyzed and re-analyzed WHI trial data and other studies, they have found support for a "timing hypothesis" -- that estrogen's heart protection occurs when it is started close to the time of menopause. By age 60, research suggests, changes in blood vessel cells compromise estrogen's ability to inhibit hardening of the arteries (a heart disease risk) and to promote good blood flow.
This new study finding should reassure women who had a hysterectomy and began estrogen at the time of menopause, said Dr. Jennifer Leighdon Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City, who was not involved in the analysis.
"I think we always knew from the WHI study that the estrogen-progestin combination was more dangerous than estrogen alone," she said. However, women tended to lump the findings of adverse effects together for both types of treatment, even though the risks and benefits were different, she said.
Even with the new results, Wu said it's crucial to individualize treatment with hormone therapy. "You wouldn't just put every patient who had a hysterectomy on estrogen," she said.