The War over Hormone Replacement Therapy Evens Out

Hormone replacement therapy (HRT) to treat menopausal estrogen deficiency has been in widespread use for over 60 years. Several observational studies over the years have shown that HRT use by younger postmenopausal women has been associated with a significant reduction in total mortality. Until 2002 and the publication of a large and negative study, HRT was supported by the available evidence because it appeared to increase longevity in postmenopausal women.

That changed after the publication of the "Women’s Health Initiative" or WHI study, which received a great deal of publicity. This trial indicated increased risk for negative outcomes in older women. Since then, there has been rigorous debate regarding whether Hormone Replacement Therapy is beneficial or harmful. Now, in an article published in the November 2009 issue of The American Journal of Medicine, researchers write about a very large review of all the available data using a scientific method of analysis called "Bayesian methods." During this new research it was concluded that HRT almost certainly decreases mortality in younger postmenopausal women.

The authors pooled results from 19 randomized trials that included age-specific data from the earlier WHI trial, with 16,000 younger postmenopausal women (mean age 55 years) followed for 83,000 patient-years, and showed that the mortality relative risk was much less than had been earlier stated.

Shelley R. Salpeter, MD, says in the article, “It is clear that these findings need to be interpreted in the light of potential benefits and harms of hormone therapy. The available evidence indicates that hormone therapy in younger postmenopausal women increases the risk of breast cancer and pulmonary embolism and reduces the risk of cardiovascular events, colon cancer, and hip fracture."

The reduction in deaths from coronary heart disease, fracture, and colon cancer outweighed the increase in deaths from breast cancer, stroke and pulmonary embolism. Is it a wash in your case? Talk to your doctor. He or she may tell you that in addition to this mortality benefit, hormone therapy in younger women provides an improvement in quality-of-life measures, at least in the first few years of treatment.

Dave