HRT not such a bad idea after all!

Jun 21 2007

Older women struggling to cope with the symptoms of the menopause will be reassured by the latest research into hormone replacement therapy (HRT).

Many such women became alarmed over HRT five years ago when a landmark study scared millions of women away from taking hormones for menopause symptoms, after researchers detected higher rates of heart attacks, strokes, breast cancer and other problems in women who took an estrogen-progestin combination pill.

This new research however which says estrogen may offer some heart benefits for certain younger women who start taking them at the start of menopause, is the latest to suggest that women gain health benefits beyond relief from hot flashes.

It appears such women suffered less from hardening of the arteries than those who took a placebo; but women should be aware because those who start taking them in their 60s and 70s increase their health risks.

However the overall advice remains that women in general should use hormones at the lowest possible dose and for the shortest possible time, no longer than four or five years, to treat hot flashes, sleeplessness and other symptoms at the start of menopause.

The new research examined how menopause hormones affect the risk of cancer, Alzheimer's disease, stroke and heart problems, and whether those risks and benefits differ by age.

Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital and the study's lead author says they reached the conclusion that women who started taking estrogen pills in their 50s were 30 to 40 percent less likely to have measurable levels of blockage-causing calcium in the arteries that lead to the heart.

This research is again based on the Women’s Health Initiative, a huge federal study started in the 1990s that focused on the risks and benefits of hormones for menopausal women; the first phase of which initiated the panic five years ago when the study was suspended and millions stopped taking the hormones.

At that time the heart attack issue was the surprising revelation, then in 2004 researchers saw higher risks for strokes and blood clots in women who took estrogen alone.

Since those initial scares scientists have been able to put the results into perspective and have noticed for example that most of the women in the study were in their 60s or 70s when the research began while recent analyses focuses on women who were in their 50s when they joined the study.

Current research is exploring a "timing hypothesis" where estrogen only helps prevent clogged arteries and heart disease when given before problems develop and before natural estrogen levels have been low for an extended period of time.

Experts believe estrogen can trigger heart attacks in women who have advanced atherosclerosis.

The new research by Manson and her colleagues focuses on more than 1,000 women in their 50s who had hysterectomies and were given either estrogen or dummy pills for an average of about 7.5 years.

The women who were by then on average 64 years old, had cardiac scans done in 2005 to check for buildup of calcium in the arteries.

Some experts have welcomed the findings as they say it is evidence that estrogen, started at the right time, can be taken for decades.

Other experts believe the risks for stroke and blood clots remain with continued hormone use and say women who want to prevent heart disease should focus instead on healthy eating, exercise and not smoking.

Dr. Manson says while the results should be reassuring to women in their 50s who have been taking estrogen for their menopausal symptoms, HRT is not completely safe and women should not take it unless they have a good reason to.