Risk of developing diabetes increasingly involved in decisions regarding HRT

Although doctors for years have "talked about the health effects of hormones on bones, breasts and women's hearts," diabetes has not been "part of the debate" until last week, when the North American Menopause Society in a revised position statement said that women taking hormone replacement therapy appear to be less likely to develop the disease, the Wall Street Journal reports (Parker-Pope, Wall Street Journal, 2/3).

Along with a lower risk of diabetes, benefits of HRT include fewer hot flashes; better sleep; a lower risk of colon cancer; stronger bones; and, potentially, improved blood pressure, lowered risk of dementia and better "heart health."

Women taking HRT have a higher risk of stroke, blood clots and gall bladder disease, as well as a possible higher risk of ovarian cancer and poor bladder control.

Breast cancer risk is higher for women taking HRT containing estrogen and progestin, but estrogen-only HRT might lower the risk of breast cancer.

The society in the revised position statement cited data from the Women's Health Initiative that found women who used estrogen and progestin were 21% less likely to develop diabetes, while women who took only estrogen were 12% less likely to develop the condition.

The risks and benefits of HRT for prevention of cardiovascular disease, diabetes and osteoporosis still are unclear, according to the society's statement (Kaiser Daily Women's Health Policy Report, 1/26).

In addition, the society cited another study that found a combination of estrogen and progestin reduces the chance of developing diabetes by 35%.

According to the Journal, HRT use might lower women's chances of developing diabetes because it reduces elevated insulin levels in the blood.

Women enrolled in WHI using estrogen and progestin experienced a small drop in insulin levels after one year, and women taking HRT lost more weight compared with those taking a placebo.

"We've not addressed diabetes in the past," Wulf Utian, executive director of the society, said, adding, "But there now are a number of studies suggesting that estrogens are having a beneficial effect on sugar metabolism."

Despite the findings, many physicians argue that lowering diabetes risk is not a good enough reason to take HRT.

They recommend that HRT should be prescribed only to women experiencing hot flashes, sleep problems and other menopause-related symptoms.

"The evidence with regard to diabetes is just beginning," Utian said, adding, "We didn't see this as a sole indication for prevention of diabetes, but we do see it as a potential benefit of hormones" (Wall Street Journal, 2/3).