Hormone Replacement Therapy Safety Revisited

A prestigious group of world-renowned experts on menopause have joined forces for a re-evaluation of the controversial use of hormone-replacement therapy (HRT) for healthy women experiencing distressing symptoms of menopause.  Once hailed as a desirable antidote to some of the most common symptoms of menopause, HRT fell out of grace in 2002 after research pointed to an increased risk of heart disease and breast cancer in women receiving the therapy.

The panel of experts convened for the First Global Summit on Menopause-Related Issues in Zurich, Switzerland, on March 29 and 30.  One key area of discussion was the comparison of actual safety versus public perception, especially with regard to four key areas of concern:  bone density, breast health, cardiovascular effects, and cognitive impairment.  During the World Congress on Menopause, scheduled for May 20 in Madrid, Spain, Professor Amos Pines, president of the International Menopause Society, will lead a presentation of the findings of the Zurich summit.

Of interest is the health and fitness level of the women in the 2002 Women’s Health Initiative (WHI) study which concluded HRT posed enough risk to limit its use to just worst-case scenarios.  The Zurich summit does not consider these individuals as fully representative of the average woman seeking relief via HRT.  Particularly:

  • Average age of women involved in the WHI study is 63 whereas most women begin treatment for menopausal symptoms a good ten years earlier.
  • In the WHI study, 36% of all study participants were diagnosed with hypertension;
  • 49% were current smokers or had a history of smoking; and
  • 34% were found to be clinically obese.

Each of the factors listed above elevates a woman’s risk for both breast cancer and cardiovascular disease, even without HRT.  More recent data from the WHI study reveals that age at onset of HRT plays a critical role in the safety of the treatment.

In addressing the four key areas of concern, the Zurich summit panel concludes:

  • Bone density:  When taken between the ages of 50 and 59, HRT does protect against estrogen-related bone loss.
  • Breast health:  Women with no history of using estrogen for any reason experienced no added risk for breast cancer when taking HRT.  HRT that combines estrogen and progesterone can generate a slightly elevated risk of breast cancer but this risk is outweighed by other risk factors.  Every woman considering HRT is urged to discuss all risk factors, including family history, with their prescribing physician before beginning treatment but women who are found to be generally healthy have little to fear when undergoing HRT.
  • Cardiovascular effects:  Healthy women aged 50 to 59 who were taking a combination of estrogen and progesterone HRT showed no increased risk of chronic heart disease while those taking estrogen alone actually enjoyed a decreased risk for such disease.
  • Cognitive impairment:  In healthy women aged 50 to 59, no cognitive impairment was discovered.  Research actually points to a delay of cognitive impairment for healthy women in this age group when taking HRT.

The Zurich panel concludes that otherwise healthy women aged 50 to 59 are excellent candidates for HRT, which has been proven to be both safe and effective.  The panel does stress the individuality of each woman and urges every woman to seek the advise of her doctor with regard to the effectiveness of HRT on a case-by-case basis.

The Zurich summit’s conclusions concur with recent conclusions published by the American Association of Clinical Endocrinologists and the North American Menopause Society.

Source: International Menopause Society