Rethinking Use of Hormones for Menopause Symptoms

Rethinking the Use of Hormones to Ease Menopause Symptoms – The New York Times –  By Jane E. Brody – August 29, 2016

Ever since the large government study called the Women’s Health Initiative found a number of risks associated with menopause hormones, millions of women who are in or near menopause have been weathering hot flashes and other symptoms on their own.

But now, new research suggests that the benefits of short-term hormone treatment to control life-disrupting menopausal symptoms outweigh the risksas long as the treatment is started at or near menopause.

Until the early 2000s, many women with menopausal symptoms took hormone replacement therapy — H.R.T. — to counter them. Even some who did not have disturbing symptoms used H.R.T. because observational studies indicated it lowered the risk of cardiovascular diseases, and popular books and articles suggested it delayed signs of aging. 

Then in 2002, the results of the largest randomized clinical trial of hormone replacement, the Women’s Health Initiative (W.H.I.), created a kind of menopausal panic, prompting millions of middle-age women to stop or not start hormone treatments and doctors to not prescribe them.

However, according to Dr. JoAnn E. Manson, an endocrinologist and one of the principal investigators for the W.H.I., “The W.H.I. findings have been seriously misunderstood and misinterpreted,” and millions of women for whom the benefits clearly outweigh the risks are needlessly being denied treatment. “The pendulum has swung too far,” she said.

In the years after the W.H.I. findings, many new analyses and studies have prompted experts to rethink the wisdom of avoiding hormone replacement, especially for women within a few years of menopause whose personal and family history do not place them at high risk of breast cancer.

Experts like Dr. Manson, professor of medicine at Harvard Medical School and Brigham & Women’s Hospital, maintain that the results of the W.H.I. study are not relevant to the more common use of H.R.T. for women in their 50s and for those experiencing earlier menopause as a result of medical treatments.

Dr. Howard N. Hodis, a preventive cardiologist at the University of Southern California, said the billion-dollar W.H.I. study made “a big mistake” by starting the hormones in older women, when cardiovascular damage may have already occurred.

“The cardiovascular protection found in observational studies involved women who were younger and within a few years of menopause when they started taking H.R.T.,” he said.

In an analysis in 2013 in the American Journal of Public Health, Dr. Philip M. Sarrel and his co-authors calculated that, based on reduced death rates among women taking only estrogen in the W.H.I. study, avoiding hormone replacement resulted in the premature deaths of 18,601 to 91,610 women in the decade after the study’s release.

Dr. Manson is distressed about the large number of women — about a third of those now on hormone replacement — who are relying on “custom-compounded” products that have not been reviewed for safety and effectiveness by the Food and Drug Administration. They come with no warnings in a package insert and could contain contaminants and inconsistent dosages, she said.

“Women today have so many options — a wide array of doses, from low to traditional, and ways to use them.”  

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