Evidence Accumulates That HRT Benefits Overwhelmed by Risks
Wednesday, October 8th 2003
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 products are all useful for HRT alternatives :
Related health information can be found here:
7-Keto DHEA, the fountain of youth hormone
Chaste Tree (Vitex agnus castus) as a hormone balancer
DIM Plus to assist in cancer prevention
Herbal phytoestrogens and menopause
Suffering from menopausal symptoms? Femitone may help
Related articles can be found here:
Current Combined HRT Use Doubles Risk of Breast Cancer
Doctors to Curtail Hormone Therapy
Estrogen-Progestin Associated With Increased Risk of Stroke and Dementia
Fat Intake Linked to Breast Cancer in Premenopausal Women
Low Bone Mineral Density Linked to Dementia in Women
Menopause Not Linked to Decline in Cognitive Functioning
Soy Protein With Isoflavones Has Favorable Effect on Lipids in Postmenopausal Women
Women To Get Warning On Injection
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