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HRT does not affect women's death rates

Women who took hormone replacement therapy back in the 1990s are no more likely to die decades later than women who were given sugar pills.
/ Source: NBC News

Women who took hormone replacement therapy back in the 1990s are no more likely to die decades later than women who were given sugar pills, a new study finds.

It’s the latest reassurance for menopausal women who dumped HRT in droves after they learned it raised the risk of breast cancer and might raise the risk of stroke.

The study shows that women who took HRT 18 years ago are no more likely to die of anything than women who did not.

“I think we can provide reassuring evidence that hormonal therapy is not going to kill you,” said Dr. JoAnn Manson of Brigham and Women’s Hospital and Harvard Medical School in Boston, who led the study.

Lisa Steimel wishes she had known that.

Now 56, Steimel toughed out menopause because of worries about cancer.

“Everything that I had read, the headlines, everything in the paper, on the news, said it wasn’t a good thing to do any more,” said Steimer, an elementary school aide from Wyckoff, New Jersey.

Lisa Steimel
Lisa Steimel watched her mother cope with the symptoms of menopause by taking HRT. But by the time she hit menopause, she worried about hormone drugs.

“There are a lot of people who went through a lot of worry and a lot of fear and struggled through all those menopausal symptoms when maybe they didn’t have to.”

Still confusing for women

But the findings are unlikely to change things much now, says Dr. Wendy Hurst, a practicing gynecologist in Englewood, New Jersey.

Women are no longer told to take HRT to prevent heart disease or to keep their bones strong. Now they’re told it’s an option to reduce the symptoms of menopause, such as sleeplessness and hot flashes.

“This is reassuring information but it still leaves open the fact that it’s very confusing for women,” said Hurst.

“The pendulum has swung back and forth. First, when I was practicing 27 years ago, there was no question. ‘You’re going on hormones. You’re going on hormones. They’re all good.' Then we get the Women’s Health Initiative and the pendulum swings back the other way and everybody is fearful. And I think this fear is going to continue despite this study.”

Hormone replacement therapy once was standard for women going through menopause. The idea was that giving women back the estrogen their bodies were no longer producing would protect them against heart disease, cancer and osteoporosis.

Less importantly to doctors, it also relieved the hot flashes, sleeplessness and other life-altering symptoms of menopause.

Then a large study called the Women’s Health Inititative showed that in fact, HRT raised the risk of cancer, especially breast cancer and didn’t lower the risk of heart disease. Almost overnight, millions of women stopped taking it.

In 2001, 17.9 million U.S. women too at least one HRT drug. By 2008, that plummeted to 5.8 million, according to the Agency for Healthcare Research and Quality.

Now it’s clear the story isn’t so simple. Doctors have found that younger women who are just entering menopause are not in as much danger of harmful side-effects as older women long past menopause.

They’ve found that lower-dose HRT formulations may be safer. And new delivery methods, such as patches and creams, may also avert some side-effects such as blood clots.

'Hormonal therapy is not going to kill you'

The study published Tuesday in the Journal of the American Medical Association looks at the records of more than 27,000 who took HRT or a placebo in the 1990s and were followed for about 18 years.

About 27 percent of women died over that time: 27.1 percent of the women who took HRT, and 27.6 percent of the women who did not.

Manson, who led the original Women’s Health Initiative and the follow-up studies, said the biggest question women have has been answered.

“I think we can provide reassuring evidence that hormonal therapy is not going to kill you."

“Many of them are very worried and concerned that this going to increase their risk of dying from cancer. That’s what people worry about: is the medication going to kill them?” she said.

“I think the findings provide reassurance for women who seeking hormone therapy for the purpose of treating bothersome symptoms, hot flashes…in early menopause.”

Steimel had watched her mother cope with the symptoms of menopause by taking HRT. But by the time Steimel hit menopause, public opinion had changed.

“I do remember thinking, ‘Oh crap. How am I going to get through this if the drugs they used to treat it all along are not OK any more?” she said.

She decided to just put up with the symptoms.

“If I could beat it myself and just put up with the pain in the neck of having these hot flashes and night sweats, it’s horrible but not that bad. I felt it was better to beat it myself than take something that was life-threatening,” said Steimel.

An individual decision

HRT wasn’t always considered a risk for every woman. Teresa Hutchens of Charlottesville, Virginia went through menopause at 36 after a hysterectomy. Hutchens did not hesitate to take estrogen replacement pills and for her, they were strongly recommended medically.

“I certainly did not want to contend with hot flashes and mood swings when I was 36 and trying to raise my family.”

Hutchens, now 61, just stopped taking estrogen pills six months ago. She’s suffering now. “Hot flashes out the wazoo. It’s just craziness,” she said. “That’s enough by itself to drive you stark, raving mad.”

So what should women do now? Both Manson and Hurst say it’s really an individual decision.

“There is still a very real concern with breast cancer,” said Hurst. “That is what people are afraid of.”

Manson said it’s clear that over a large population, the higher risk of breast cancer, for instance, is balanced by the lower risk of endometrial cancer.

“During the 18 years of follow-up, there were 2,207 deaths from cancer in the overall pooled cohort, and cancer mortality rates were almost identical between hormone users and nonusers,” Dr. Melissa McNeil of the University of Pittsburgh Medical center, who was not involved in the study, wrote in a commentary.

Hurst said it will come down to each woman’s individual risk and family history.

“Some women have much more severe symptoms than others,” Hurst said.

“Someone with liver disease…they are not going to be candidates for estrogen therapy,” she added. “I think it is like any other medication. If you don’t need it, don’t take it.”