Hormone therapy for menopause is one of the most divisive subjects in medicine, hailed by some as a boon to women’s comfort and well-being, vilified by others as a threat to health.
A new analysis finds truth somewhere in the middle, reaffirming previous warnings that the drugs have more risks than benefits for most women — but also stating that the harms are low early in menopause and that hormones are “appropriate for symptom management in some women.”
Dr. JoAnn Manson, the first author of the analysis and a professor of medicine at Harvard’s medical school, said the findings “should not be used as a basis for denying women treatment if they’re in early menopause and have significant distressing symptoms.”
The new report, published Tuesday in The Journal of the American Medical Association, is based on long-term data from the Women’s Health Initiative, a large, federally funded study that turned medical thinking on its head a decade ago by uncovering the risks of hormones.
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The new report is the first to include extended follow-up data from the health-initiative study, an additional six to eight years’ worth of information on about 80 percent of the original participants.
For combined hormones, for every 10,000 women taking the drugs, the new analysis found that there were six more coronary events, nine more strokes, nine more blood clots in the lungs and nine more cases of breast cancer. On the benefit side, there were six fewer cases of colorectal cancer, one fewer case of uterine cancer, six fewer hip fractures and one fewer death. Most of the effects wore off once the drugs were stopped, but the risk of breast cancer remained slightly elevated.
Women who took estrogen alone had a reduced risk of breast cancer and heart problems; the reason is not known. For other conditions, the results were similar to those for combined hormones. But it is important to emphasize that estrogen alone can be given only to women who have had their uterus removed, because estrogen alone increases the risk of uterine cancer. In women who still have a uterus, the estrogen must be combined with some form of progesterone, which can protect the uterus.
For both types of hormone treatments, the risks were lowest in the youngest women, from 50 to 59, and highest in women from 70 to 79.