Report: HRT Safest When Taken for Shortest Duration During Middle Age

Patient Expert

Thinking about hormone replacement therapy? If so, researchers still are finding that short term usage at a younger age is the best option.

Researchers reviewed data from the Women's Health Initiative (WHI) Hormone trials as well as the extended post-trial follow-up.   The original study, which is funded through the National Institutes of Health's National Heart, Lung and Blood Institute, collected data on 27,347 women between the ages of 50 and 79 over a 13-year period. Eighty-one percent of the participants agreed to continue follow-up after the planned end of the trials. This continuation allowed researchers to compare the rates of coronary heart disease, heart attack, stroke, breast cancer, blood clots in the lungs, colorectal cancer, endometrial cancer, hip fracture and death between women who were assigned to take hormone replacement and women who were give placebo pills. Other outcomes that were studied included dementia, other types of cancer, other types of fractures, diabetes, gallbladder disease, urinary incontinence, hot flashes, night sweats, sleep disturbances, depression, breast tenderness and joint pain.

This new analysis offers for the first time data from the extended follow-up and highlights findings about conditions that affect   the quality of life of women.   "The combination of the six to seven years of intervention combined with the extended post-intervention follow-up make these hormone therapy medications among the best studied medications in medical history," said Dr. JoAnn Manson, a principal investigator for the Women's Health Initiative; chief of the division of preventive medicine at Brigham and Women's Hospital; and professor of medicine at Harvard Medical School. "There are very few other treatments with this much information about the balance of benefits and risks over such a long period of time that include such a long post-intervention phase. The ultimate goal of this paper and the analysis is to help women and their health care providers make informed decisions."

The researchers' analysis found that hormone therapy should not be used for the prevention of chronic disease. However, this type of therapy may be considered a reasonable option for younger women who need assistant with short-term management of symptoms brought on by menopause.

Here were some of the findings:

  • The rates of overall illness - which was defined as any of the major illnesses that were studied - and death were 12 percent higher among women who were taking estrogen and progestin than in women who were given the placebo pills.
  • Women who took estrogen-alone therapy had similar rates of overall illness and death when compared to the group taking the placebo. However, these rates differed by age. Women who were taking estrogen alone when they were in their 50s had a 16 percent reduced risk of overall illness and death.   For this group, there were 18 fewer major illnesses or deaths per year for every 10,000 women in this group when compared to the same number who were taking the placebo.
  • Women who were in their 70s who were taking estrogen-alone had a 17-percent increased risk of overall illness and death. This group also had 51 more major illnesses or deaths per 10,000 women per year when compared to a similar group of women who were taking the placebo.

"Decisions about hormone therapy are not easy, but these findings provide an evidence base for finding a way forward," said Jacques Rossouw, M.D., chief of the Women's Health Initiative Branch within the NHLBI's Division of Cardiovascular Sciences. "Hormone therapy affects many organ systems in the body and changes the risks of many diseases some in good ways, others in bad ways. Depending on hysterectomy status, age, and other individual factors, the consequences can vary dramatically. The WHI emphasizes the need for women to talk about their risk factors with their doctors before making any decisions regarding hormone therapy."

Primary Source for This Sharepost:

National Institutes of Health. (2013). Women's Health Initiative reaffirms use of short-term hormone replacement therapy for younger women.