Ethics in Medicine

Hormone Use in Menopause Still in Doubt

Kristen Sparrow • October 02, 2013


woman doctor
Not so sure about hormone replacement…

Traveling ( in Stockholm for the ISAMS conference) so won’t discuss this at length.  But noteworthy is how nuanced any advantages of hormone therapy are.  Go natural, take herbs and get acupuncture.  First, Do No Harm.

October 1, 2013

Study of Hormone Use in Menopause Reaffirms Complex Mix of Risks and Benefits


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 E. Manson, the first author of the analysis and a professor of medicine at Harvard’s medical school, said in an interview that 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 on 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…
For combined hormones, for every 10,000 women taking the drugs, the new analysis found that there were six additional instances of heart problems, 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 actually had a reduced risk of breast cancer; the reason is not known. For other conditions, the results were similar to those for combined hormones. But 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.
For both types of hormone treatments, the risks were lowest in the youngest women, ages 50 to 59, and highest in women from 70 to 79.
In 1993, when the study began, millions of women were taking the drugs to relieve hot flashes and vaginal dryness. There was also a widespread belief that hormones would keep women youthful and feminine, and prevent heart disease and dementia…
Dr. Elizabeth G. Nabel, a professor of medicine at Harvard who wrote an editorial accompanying the new report, said in an interview that seemingly small risks could be significant for individual patients, particularly people with family histories of breast cancer, heart disease or strokes.
This article has been revised to reflect the following correction:
Correction: October 3, 2013