Study: Health benefits of estrogen outweigh risks
Prior research warned of danger of taking hormone
LOS ANGELES -- Nearly five years after government scientists told women that taking estrogen replacement therapy increased their risk of heart attacks and strokes, researchers have concluded that the drugs are beneficial for many after all.
Continuing analysis of the original data indicates that the researchers raised a false alarm for most women and that, if women begin taking the hormones shortly after menopause, the drugs do not raise the risk of heart disease and, in fact, might lower it.
The latest piece of evidence, in today's New England Journal of Medicine, shows that taking estrogen for seven years or more after menopause reduces calcification of the arteries -- one of the key indicators of atherosclerosis -- by as much as 60 percent. High levels of calcification are generally considered a predictor of increased risk for a heart attack.
The only group of women at significant risk from the drugs are those who delay taking them for at least 10 years after menopause, experts said.
The findings "provide some additional reassurance for women who have been denying themselves relief" from hot flashes and other symptoms of menopause, said Dr. JoAnn Manson of Brigham and Women's Hospital in Boston, who led both the original study and the one to be published today.
Virtually all researchers agree that women should not hesitate to use hormone replacement therapy, commonly called HRT, to mitigate their symptoms when menopause begins. The debate now is over how long they can safely continue to do so.
Dr. Elizabeth G. Nabel, director of the National Heart, Lung and Blood Institute, which sponsored the studies, said the new findings "do not alter the current recommendations that when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible, and hormone therapy should never be used to prevent heart disease."
But Dr. Howard Hodis, director of the atherosclerosis research unit at the University of Southern California, countered that "there is absolutely no evidence, none, zero, that if you start a woman on estrogen at menopause and continue until she is 80, the risk goes up as she gets older."
There is an increased risk of breast cancer with age for estrogen plus progestin, Hodis said at a news conference Tuesday sponsored by
"We will never know when we should stop hormones," said Dr. Michelle Warren of the Columbia University College of Physicians and Surgeons, who spoke at the same news conference and who argued for the shortest use possible.
But "If you have been on the hormone since the time of menopause, I am not worried anymore," she added.
The long-term use of hormone replacement therapy was popularized in 1966 after the publication of "Feminine Forever" by Dr. Robert A. Wilson, who argued that it was a panacea for all menopausal ills. A host of animal and small human studies subsequently suggested that the hormones could help ward off heart attacks and increase bone density while alleviating menopausal symptoms.
Dr. Robert W. Rebar, executive director of the American Society for Reproductive Medicine, concluded: "We are clearly learning that the benefits of estrogen in young, healthy, symptomatic post-menopausal women outweigh the risks."
