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Did Avoidance of Hormone Therapy Harm Certain Women?

For older women without a uterus, estrogen may save lives, researchers say
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WebMD News from HealthDay

By Kathleen Doheny

HealthDay Reporter

THURSDAY, July 18 (HealthDay News) -- Widespread discontinuance of hormone replacement therapy in the past decade possibly contributed to the deaths of nearly 50,000 U.S. women who had had a hysterectomy, a new analysis contends.

The findings refer only to women who've had a hysterectomy and then experience menopausal symptoms, the researchers emphasized.

"In women who have had a hysterectomy who have symptoms of hormone deficiency [such as hot flashes], it can be lifesaving for them to take estrogen," said review author Dr. Philip Sarrel, of Yale University School of Medicine.

For women between the ages of 50 and 59, estrogen-only therapy after a hysterectomy reduces the risk of heart attack and death, Sarrel said.

"The main reduction [in deaths] is the reduction in heart attacks, but there is also a clear reduction in the incidence of breast cancer and deaths from breast cancer," Sarrel said.

The use of hormone therapy -- both estrogen-only and the combination of estrogen plus progestin -- declined greatly after the U.S. Women's Health Initiative Study found in 2002 that combination therapy had ill effects, including an increase in breast cancer, heart disease, stroke and blood clots. Prescriptions for both regimens plummeted even though the research didn't apply to women without a uterus or to women on estrogen-only therapy, said Sarrel, who is a consultant for Noven Therapeutics, which makes an estrogen patch.

Subsequent trials found health benefits for women who took estrogen-only therapy after a hysterectomy, compared to those who took a placebo. According to a 2011 report, estrogen-only therapy could reduce 13 deaths per 10,000 women a year among this population.

Despite those findings, prescriptions for estrogen-only therapy after hysterectomy remain low.

The new analysis, published online July 18 in the American Journal of Public Health, was funded by the U.S. Centers for Disease Control and Prevention. For the study, Sarrel and his colleagues analyzed U.S. census data, the hysterectomy rate and the decline in estrogen use in this group of women, and calculated which deaths could be attributed to estrogen avoidance.

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