Entries in Hormone Therapy (7)


Hormone Therapy Without Menopause Symptoms Discouraged

iStockphoto/Thinkstock(WASHINGTON) -- The U.S. government renewed its recommendation against prescribing hormone therapy to postmenopausal women for the prevention of chronic conditions like heart disease and bone loss, but didn't tackle whether women should take hormones to relieve their hot flashes and night sweats.

"The evidence shows that the harms of hormone therapy for the prevention of chronic conditions outweigh the benefits, which is what the evidence also showed in 2005," said Dr. Kirsten Bibbins-Domingo, a member of the Task Force.  The task force only looks at preventative medicine and would not typically make a recommendation regarding whether women should use hormone therapy to relieve their menopause symptoms.

Since doctors haven't regularly prescribed hormones for chronic disease prevention since 2002 study findings showed the dangers of long-term hormone therapy, some doctors are worried patients will be confused by the Task Force recommendation.

"At the present time, the pendulum has already swung away from the use of hormone therapy for chronic disease prevention," said Dr. JoAnn Manson, chief of preventative medicine at Brigham and Women's Hospital in Boston.  "Recently, the consensus of the 15 top medical societies saying hormone therapy still has an important clinical role in management of night sweats and other menopause symptoms."

Like birth control and other drugs, hormone therapy comes with a set of risks, Manson said.  As such, doctors should not prescribe them if they outweigh the benefits for a particular patient.  If the patient has no symptoms, which would be the case if she is taking hormone therapy simply for "chronic disease prevention," the risks do not outweigh the benefits.

Two hormone therapy studies came out within a week of each other this month, generating excitement in the medical community because they showed positive results of using short-term hormone therapy for women who start it shortly after their last menstrual period: the Kronos Early Estrogen Prevention Study nicknamed KEEPS, and a Danish study.

However, the Task Force did not consider either of them because they were not available when it was making its decision, Bibbons-Domingo said.

"In the context of the larger body of evidence the Task Force considered when making this recommendation, it is unlikely that this study would have altered the balance of harms versus benefits and led the Task Force to a different recommendation," Bibbons-Domingo said.

According to the review published in the Annals of Internal Medicine, researchers looked at studies from 2002 forward and chose nine on which to base the Task Force recommendation.  They found that estrogen and progestin reduced bone fractures but increased invasive breast cancer stroke and other ailments.

The first study to raise the alarm on hormone therapy was the Women's Health Initiative, or WHI, which stopped prescribing hormone pills to its 160,000 participants between the ages of 50 and 79 in 2002, the year it found that the hormones made women more likely to develop aggressive breast cancer.  The participants has been taking the pills for 10 years because doctors believed the pills would prevent chronic diseases.  Follow-ups continued through 2010.

This study was included in the Task Force's recommendation, but Dr. Katherine Sherif, director of the Drexel Center for Women's Health, said the WHI was misleading because its participants were 10 years older than most hormone therapy patients today.

"I've been in this business for 17 years, and no woman who is 63 has ever said to me, 'I need hormones for hot flashes,'" Sherif said, adding that most of her patients are in their late 40s or early 50s.  "It irritates me that people keep falling back on the Women's Health Initiative in that hormones are dangerous for women.  It just isn't that clear cut."

This month, KEEPS followed 727 women ages 42 to 58 (much younger than WHI) for four years, but researchers didn't have enough time to study long term health outcomes like cancer, heart disease and death.  As such, they looked for risk factors, and found that hormone pills made no difference.  KEEPS has yet to publish its data.

The following week, researchers at Hvidovre Hospital in Denmark announced that they'd found proof of the timing hypothesis, which suggests that hormone therapy protects women from heart disease if they start it soon after their last menstrual period.  It looked at 1,000 women ages 45 to 58 over 16 years.  Researchers also found that fewer women on hormone therapy were diagnosed with breast cancer, but the figure wasn't statistically significant.  As such, they concluded hormone therapy did not increase breast cancer risk.

Manson said more research is needed on lower doses of hormone therapy for menopause symptom relief.

Copyright 2012 ABC News Radio


Study Finds Hormone Therapy Safe in Early Menopause

iStockphoto(NEW YORK) -- Researchers in Denmark have become the first to offer statistical proof that hormone therapy is not only safe for menopausal women who begin it early -- it actually reduces their risk of mortality, heart attack and heart failure.

The 16-year randomized study of about a thousand women offers new proof that the "timing hypothesis," which suggests that hormone therapy protects women from heart disease if they start it soon after their last menstrual period, is correct. Researchers also saw no difference in breast cancer risk between those who were assigned the hormone therapy and those who were not.

"It really confirms the timing hypothesis and hopefully will change the way we look at hormone therapy, so it will change the quality of life for many women," said study author Dr. Louise Schierbeck, who works in the department of endocrinology at Hvidovre Hospital in Denmark.

The women took estrogen for about ten years until 2002, when another study, the Women's Health Initiative (WHI), found significant evidence that women taking progestin and estrogen were more likely to develop aggressive breast cancer. Although WHI researchers studied 160,000 women ages 50 to 79, many of whom had chronic diseases already, Danish researchers studied 1,000 women ages 45 to 58, and excluded people who previously had had cancer or other major illnesses, according to the study text, which was published in the BMJ, formerly the British Medical Journal.

Schierbeck's colleagues used Danish hospital data to figure out how many patients died or had other health problems in 2002 and six years later. Both times, they discovered that fewer hormone therapy patients died or had heart disease than the hormone-free patients.

Researchers additionally found that fewer hormone therapy patients had breast cancer or other cancers, but because the findings were not statistically significant, they can only officially conclude that there was no difference in cancer risk for the hormone therapy group and the hormone-free group, Schierbeck said.

Although the study is much smaller than WHI, doctors in the United States are calling it "important" and "encouraging" because it shows that women can relieve their menopausal symptoms, such as night sweats and hot flashes, without worrying that the long-term hormone therapy will eventually kill them.

The study will not affect current guidelines, which recommend as little hormone therapy as possible, because larger studies will be needed to affirm the findings, several doctors agreed. They were especially interested in how the study looked at women who were on hormone therapy for 10 years, which is longer than the WHI study participants were on it.

"This study is likely to lead to a resurgence of interest in studies of how hormones affect the cardiovascular system related to age and to the level of underlying pathology," said Dr. Carl Lavie, the medical director of cardiac rehabilitation and prevention at Ochsner Clinic Foundation and Hospital in New Orleans.

Still, some medical professionals were not convinced this study is a big step at all.

"This is a non-informative study with too many shortcomings to list," said Wulf Utian, the founding president and former executive director of the North American Menopause Society, or NAMS. (Preliminary findings of a different study were announced at the NAMS annual conference in Orlando last week.)

What shortcomings? The trial had an "extremely small" number of adverse health events, no placebo control and no description of the randomization method, Utian said.

Shierbeck responded to the study size criticism by saying that she reported statistically significant results.

Pamela Ouyang, a Johns Hopkins professor, said that the 1,000 women followed for almost two decades provides an enormous number of "woman-years" worth of data. Ouyang was one of the doctors who suggested that the guidelines would be rewritten because of this study.

Every doctor interviewed said that women should discuss hormone therapy with their doctors.

Copyright 2012 ABC News Radio


Menopause Hormone Therapy Benefits Hit in Government Report

iStockphoto/Thinkstock(WASHINGTON) -- Hormone replacement therapy may provide relief from the hot flashes, night sweats and other oppressive symptoms of menopause, but when it comes to preventing chronic health problems, a panel of experts for the federal government said HRT isn’t helpful and may be harmful.

The U.S. Preventive Services Task Force on Tuesday recommended against the use of HRT for the prevention of chronic conditions, such as coronary heart disease, breast cancer and fractures, for postmenopausal women.  The panel classified the recommendation as “grade D,” meaning there is “moderate to high certainty” that the risks of HRT outweigh any long-term health benefits that women might gain.

The panel noted that the recommendations don’t apply to women taking HRT to relieve hot flashes, vaginal dryness and other postmenopausal symptoms.  Women’s health specialists say increasing evidence indicates that reasonable use of the therapy to fight those symptoms can have big benefits for women’s quality of life.

“For newly menopausal women who have these symptoms and are in generally good health, the benefits of treatment are likely to outweigh the risks,” said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.

The USPSTF’s recommendations are the latest chapter in the often-confusing story of hormone replacement therapy, which was once considered a possible tool for preventing chronic maladies such as coronary heart disease and fractures.  But the Women’s Health Initiative, a 10-year study of nearly 70,000 women, found that women who took both estrogen and progestin actually had an increased risk of blood clots, heart attacks and strokes, as well as a higher risk of developing breast cancer.  The trial was halted three years early in 2002.

The USPSTF cited evidence gleaned from the Women’s Health Initiative in its latest recommendations, saying that the use of estrogen-only HRT or a combination of estrogen and progestin was linked with an increased risk of stroke, gallbladder disease, urinary incontinence and blood clots.

For women taking estrogen-only HRT, the panel found modest benefits in the way of reducing bone fractures and smaller reductions in the risk of developing or dying from invasive breast cancer.  But the panel said those small positives were outweighed by the more major risks of the therapy.

Copyright 2012 ABC News Radio


Estrogen Therapy Works Best in Younger Women

Jupiterimages/Thinkstock(NEW YORK) -- A reappraisal of the National Institutes of Health's Women's Health Initiative (WHI) study has found that "the age when women start hormone replacement therapy makes a huge difference," in risk of cancer and heart disease, according to Dr. Robert Langer, lead author of the reassessment, which was published in the journal Climacteric.

Researchers said "mass fear" left millions of women to needlessly suffer from menopause symptoms without the benefits of hormone replacement therapy when researchers of the WHI study found that women who took estrogen were at higher risk of certain cancers and heart disease.

New data showed that the risks only apply to older menopausal women who begin taking the medication late into menopause.

"The balance is towards benefit for women with hot flashes and other reasons to use it who start within 10 years of menopause," said Langer.  "But it's not beneficial for most women who start about 10 years or more into menopause."

Prior to the 2002 study, some research found that the menopausal hormone therapy actually helped to decrease the risk of heart disease, but the 2002 preliminary data found the treatment did not decrease risk and put women at increased risk of some invasive breast cancers and stroke.  Prior to the study results, hormones were one of the most-prescribed drugs in the country.

But the use of estrogen dropped by 71 percent from 2001 to 2009, according to the North American Menopause Society.

Researchers halted the clinical trial altogether three years early in 2002 because of the noted increased risk.

For some women, menopause symptoms are much more than the occasional hot flash.  Depression, low libido, night sweats, panic attacks and vaginal dryness are only a few of the many indications that storm through the body of a menopausal woman.

Symptoms like vaginal dryness and pain on intercourse are more difficult to bring up with a gynecologist than risks of heart disease and breast cancer, said Langer.

"Fears like the risk of breast cancer, or sometimes heart attacks or strokes, surface quickly in those discussions," continued Langer.  "The reporting of the WHI fed those fears to a degree not warranted by the small increase in breast cancer rates that probably only reflected earlier discovery of existing cancers, or by the fact that the heart attack risk and stroke was only seen in women who started more than 10 years after menopause."

Copyright 2012 ABC News Radio


Menopausal Hormone Therapy: Conflict Of Interest

Jupiter Images/Thinkstock(COLD SPRING HARBOR, N.Y.) -- The Women's Health Initiative was a landmark study which found that hormone replacement therapy increased the risk of heart disease and breast cancer. It lead to a dramatic drop in the use of hormone therapy for menopausal symptoms. But in recent years some gynecologists have been criticizing the study, saying that it doesn't apply to young women and suggesting it may be safe for some women to use hormone therapy.

Against this backdrop comes a study which provides some insights on the authors of articles or presentations supporting use of hormone replacement therapy for menopausal symptoms, which found that those authors are more likely to be funded by industry.

The authors of this study conducted a comprehensive literature review of the articles published on menopausal therapy and found that articles promoting the use of hormone therapy for menopausal women were more than twice as likely to be written by people who have potential conflict of interest rather than those who don't.

These findings, by the Cold Spring Harbor Laboratory, were published by PLoS Medicine.

Copyright 2011 ABC News Radio


HRT Linked to High Cancer Risk

Photo Courtesy - Getty Images(NEW YORK) -– Mounting evidence suggests that hormone replacement therapy (HRT) in postmenopausal women may be linked to aggressive forms of breast cancer, according to results from an ongoing Women’s Health Initiative study.
The study shows that women who take a combination of estrogen and progestin therapy may even be at a higher risk of death from the disease.

Part of the ongoing study refers to women who have not had a hysterectomy and therefore are on a combination of estrogen and progestin (Prempro) and women with hysterectomies who were taking estrogen only in the form of Premarin.
Women taking estrogen only after their hysterectomy were not at an increased risk. This finding leads many physicians to suspect that it is primarily the daily use of the synthetic progestin in the Prempro combination that contributed to the breast cancer risk.
Copyright 2010 ABC News Radio


Hormone Therapy Linked to Higher Breast Cancer Death Risk

Photo Courtesy - Getty Images(NEW YORK) -- New research results released Tuesday from the ongoing Women's Health Initiative trial found that not only do postmenopausal women who take a combination of estrogen and progestin therapy have a higher chance of getting aggressive forms of breast cancer, but that they may be at higher risk of dying from the disease.

The results, from an 11-year follow-up with more than 12,000 women who were randomly assigned to receive either the combination hormone therapy or a placebo, found 385 women taking the therapy developed an aggressive form of breast cancer, compared to 293 in the placebo group.  Twenty-five women who took hormone therapy died from breast cancer during the study, compared to 12 women in the placebo group.

"It is early in the follow-up and the number of breast cancer deaths will certainly substantially increase as we move forward," said Dr. Rowan Chlebowski, professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and lead author of the study.

Women in the study who used estrogen and progestin for five and a half years -- which is considered long-term use of the therapy -- were at higher risk of getting breast cancer, said Chlebowksi.

Earlier results of this trial indicated a connection between synthetic hormone therapy -- commonly marketed as the drug Prempro -- and less aggressive forms of breast cancer.  However, results now suggest that women who took hormones may be at risk of any, including more aggressive and late-stage, forms of breast cancer.

"For women currently on HRT, I think it warrants a significant talk with their physician as to whether they warrant the therapy," said Dr. Jennifer Litton, assistant professor of breast oncology at MD Anderson Cancer Center in Houston.

Hormone replacement therapy includes medications containing female hormones to replace the ones the body no longer makes after menopause.  Although the FDA has only approved hormone replacement therapy to reduce the risk of osteoporosis in postmenopausal women and prevent hot flashes, the medication is also likely to be prescribed off-label to control groups of symptoms such as mood swings and dryness.

While experts said diet and exercise often curb these symptoms, hormone therapy is prescribed for women with severe symptoms. "For some women, these symptoms are so severe that it's life-altering," said Litton.

Chlebowski's study initially warned of a link between combination hormone replacement therapy and breast cancer in 2002.  Since then, many doctors have prescribed a variety of combinations, including lower-dose combinations of estrogen and progestin, or estrogen alone, without knowing what type of therapy might offer the greatest benefit to women.  Many doctors say they now prescribe lower doses of the hormones at shorter intervals.

"We significantly reduced use of HRT when the link to HRT first came out [in 2002]," said Dr. Randy Wexler, assistant professor of family medicine at Ohio State University.

"There is still a role for hormone therapy," said Dr. Hugh Taylor, director of reproductive endocrinology at Yale School of Medicine.

The concern lies mainly with the combination of estrogen and progestin and not on estrogen alone, according to Taylor.

"With low doses of of estrogen we can get away with small and infrequent progestin use," said Taylor. "Let's not throw the baby out with the bathwater. Estrogen therapy is the only thing that works well and estrogen is not the cause of breast cancer."

But there's no scientific evidence that any variation of hormone therapy at any length of time provides a safer alternative. Litton said non-hormone therapies, such as antidepressants or acupuncture, may provide some women some benefit.

According to Dr. Dian Ginsberg, obstetrician and gynecologist at Children's Memorial Hermann Hospital in Houston, TX, lifestyle changes during a women's premenopausal years may help women ease through their symptoms and divert hormone therapy altogether. "I hope that as we learn more about the hormone replacement pill not being the answer, we can maybe approach the woman differently in her 30s and 40s," said Ginsberg.

Still, she said the type of therapy depends on a woman's personal history and understanding the risk and that before abandoning hormone therapy, women should talk to their doctor.

"Don't throw your hormones out," said Ginsberg.  "Call your physician, go in, learn a little bit more about this study, go over your own medical background, and see a good way, potentially, to wean off your hormone."

Copyright 2010 ABC News Radio

ABC News Radio