Evidence Accumulates That HRT Benefits Overwhelmed by Risks

Wednesday, October 8th 2003

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Even though combined estrogen/progesterone therapy (HRT) reduces the risk of fractures and endometrial cancer, the treatment's potential benefits are outweighed by heightened risk of other diseases, according to two new reports by the Women's Health Initiative (WHI) investigators.

The WHI, terminated early because of safety concerns, included 16,608 postmenopausal women ages 59 to 76 with an intact uterus recruited between 1993 and 2002. Subjects were randomly assigned to placebo or to conjugated equine estrogen, 0.625 mg/d plus medroxyprogesterone acetate, 2.5 mg/d.

Final analyses regarding fracture end points and incident invasive cancer of the ovary and endometrium after an average follow-up of 5.6 years are reported in the Journal of the American Medical Association for October 1.

According to Dr. Jane A. Cauley, of University of Pittsburgh, and colleagues, 8.6% of women in the HRT group and 11.1% in the placebo group experienced a fracture. Corresponding increases in bone mineral density at the hip after 3 years were 3.7% and 0.14% (p < 0.001).

WHI investigators had created a global index that included the earliest occurrence of seven different diseases or death. This index was increased 15% in the HRT group, "indicating more harm than benefit in women randomized to hormone therapy," Dr. Cauley's group maintains.

Even among women at high risk of fracture, the global index did not indicate net benefit. "Treatment with estrogen plus progestins should not be recommended for prevention or for treatment of osteoporosis in women without vasomotor symptoms," they advise.

Dr. Garnet l. Anderson of Fred Hutchinson Cancer Research Center, Seattle, and associates observed a hazard ratio for ovarian cancer of 1.58 among those treated with HRT, and of 0.81 for endometrial cancer; neither difference reached statistical significance.

Dr. Anderson's group also noted increased need for diagnostic procedures in response to uterine bleeding in the HRT group. Five times more HRT subjects required diagnostic biopsies, and significantly more required examination with ultrasound.

"These data provide additional support for caution in the use of continuous combined hormones," Dr. Anderson and associates conclude.

Source: Journal of the American Medical Association 2003;290:1729-1738,1739-1748

Footnote from Ideal Health

The following supplements are all useful for HRT alternatives. Use the links for more information.

Black Cohosh
Estro Soy
Estro Soy Plus
Femitone
Femone Herbal Relief Tablets
Menopause Complete

Related health information can be found here:

High Blood Pressure
Calcium Deficiency
Cancer
Blood Clots
Cholesterol
Memory
Menopause

If you need help or advice, you are welcome to email our naturopathic team with your health question.

Disclaimer: The health information presented here has been written for the New Zealand health consumer. It is of a general nature and is only intended to provide a summary of the subjects covered. The information is not intended to be comprehensive or to provide medical advice to you. While all care has been taken to ensure the accuracy of the information, no responsibility or liability is accepted, and no person should act in reliance on any statement contained in the information provided. All health ailments should be treated by a qualified health professional.

 

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