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HRT Benefits vs. Risks in Women
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HRT Benefits vs. Risks in Women - 01-30-2013, 06:35 PM

by: Melinda Beck

Benefits of Hormone-Replacement Therapy Outweigh Risks, Reviews of Studies Show

The benefits of hormone-replacement therapy outweigh the risks for women who start it near menopause.

That’s the conclusion of a series of articles in the June issue of Climacteric, the journal of the International Menopause Society, correcting a widespread impression left by the Women’s Health Initiative, or WHI, ten years ago.

Much of that big government study was halted in July 2002 after data suggested that women taking estrogen-and-progestin replacement had a higher rate of heart disease, stroke and breast cancer than those on a placebo. Millions of women and their doctors were scared away from using hormone-replacement therapy, or HRT, as a result.

Reappraisals in the years since then, as WSJ reported last fall, have found that those risks pertained mainly to women who started HT long after menopause: The average woman in the study was 12 years past menopause when treatment began.

Several experts involved in the WHI have reversed their views, or concluded the warnings were over-generalized.

“Information that has emerged over the last decade shows that, for most women starting treatment near the menopause, the benefits outweigh the risks, not just for relief of hot flashes, night sweats and vaginal dryness, but also for reducing the risks of heart disease and fractures,” said Robert Langer, who was the principal investigator at the WHI center at University of California, San Diego, in a statement. He is now at the Jackson Hole Center for Preventative Medicine in Wyoming.

Overall, the Climacteric articles support the so-called “window-of-opportunity” idea — that women who start HRT before age 60 or within ten years of menopause have a lower risk of heart disease and overall mortality, and that HRT is more beneficial than statins or aspirin.

There is a modest increase in the risk of stroke and embolism even when women start HRT early, but some studies have found that pertains to oral HRT, and not HRT in patch form.

Across the board, users of HRT have a lower risk of colorectal cancer and bone fractures, the studies say.

Other articles in the special issue say the WHI underestimated the quality-of-life-benefits HRT provides in terms of reducing night sweats, memory issues and mood swings, since so few menopausal women were included in the study. Fear of conventional HRT drove some women to seek alternative, “bio-identical” hormones to reduce discomfort from these symptoms, though there is no evidence that they are any safer or more effective, as WSJ reported in 2009.

One big fear — that HRT raises the risk of breast cancer — was exaggerated, according to another article, which noted that being overweight and drinking two alcoholic drinks per day raised the risk as much as using estrogen plus progestin. Women who take estrogen alone — usually because they no longer have a uterus — have a lower risk of breast cancer.

JoAnn Manson of Harvard Medical School, another WHI investigator involved in the Climacteric articles said in a press release: “There is no doubt that HRT is not appropriate for every woman, but it may be appropriate for many women, and each individual woman needs to talk this over with her clinician.”

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