Hormone Replacement Therapy (HRT) ~ Risks

Risks of Hormone Replacement Therapy (HRT)
Two major studies created lot of the furrow and confusion among a large population of women and medical professionals. The first, Women’s Health Initiative (WHI), was called off after Prempro, a popular estrogen and progesterone combination therapy, was shown to increase risk of stroke, heart disease and breast cancer in post-menopausal women.The second, being conducted by the National Cancer Institute (NCI), showed that post-menopausal women who took estrogen had a 60 percent greater chance of contracting ovarian cancer than did women who took no hormones.

Estrogen products have been used for decades and have helped millions of women handle symptoms of menopause, including hot flashes, night sweats, sexual discomfort and the increased risk of bone fractures.

For years, studies on heart disease, Alzheimer’s, colon cancer and bone fractures also showed potential benefits to women taking hormone replacement long-term, and these findings were widely accepted by doctors and advertised by the drug makers.

The findings regarding the benefits of estrogen on heart disease were considered strong enough by the American Heart Association to be included in its literature for women as recently as 1997.

But all this has changed over night with the findings of WHI.  Researchers running the federally funded Women’s Health Initiative announced that the largest U.S. trial of combination hormone therapy in healthy postmenopausal women had been stopped three years early because of an increase in breast cancer cases among hormone users. Increases in heart attacks, strokes and blood clots also led the oversight committee to halt the study. Overall, the researchers concluded that the treatment was hurting the test subjects more than it was helping them.

That assessment applied to women taking estrogen and progestin, but not to women in a separate study evaluating the use of estrogen alone. Researchers said that they had not detected any significant increase in breast cancer among women taking estrogen only and that the study would continue.

Experts say, women who are taking the hormones should not panic, but should consult with their doctors about whether to continue. It is advised that women who take the two hormones to relieve hot flashes and other symptoms of menopause should use the treatment as briefly as possible, and those wishing to prevent osteoporosis should probably choose alternatives to hormones.

Also, the result of this study on the use of contraceptive is unclear for the present. The observations of this study has no bearing on the use of contraceptive pills by women of pre menopausal age. This study was conducted with Prempro.

Prempro is taken all month, while oral contraceptives are prescribed to be taken for three weeks, then stopped for one week — to mimic the body’s natural hormonal cycle. Some think this cycling may be protective.

Findings of WHI in relation to HRT
Following are the observations out of the Women’s Health Initiative study:Before stopping its eight-year study at the five-year mark, the WHI came to the following conclusions:

  • Each year 30 out of 10,000 postmenopausal women taking no therapy fall ill to heart disease. For every year women took HRT, they increased their risk of heart disease by seven per 10,000. This means that for every 10,000 women taking HRT, 37 could expect to fall ill to heart disease the first year, 44 the next year, 51 the following year, and so forth. While the absolute risks are small, the increases were viewed as significant, and women’s heart risks escalated the longer they stayed on the drugs.
  • For stroke, risk rose from 21 per 10,000 (for post-menopausal women not taking HRT) to 29 per 10,000 among those taking HRT, increasing eight per 10,000 per year.
  • For pulmonary embolism, risk increased from eight per 10,000 in the post-menopausal women not taking HRT to 16 per 10,000 among HRT users, increasing eight per 10,000 per year.
  • For invasive breast cancer, risk rose from 30 per 10,000 among post-menopausal women not taking HRT to 38 per 10,000 among those taking HRT, increasing eight per 10,000 per year.
  • For colorectal cancer, risk decreased after taking HRT, from 16 per 10,000 in non-HRT users to 10 per 10,000 HRT users.
  • For hip fractures, risk decreased too, from 15 per 10,000 for non-HRT users to 10 per 10,000 HRT users.

There was no difference in death rates between the two groups. However, women on the hormone treatment had a

  • 26 percent higher incidence of breast cancer.
  • 29 percent higher incidence of heart attacks.
  • 41 percent higher incidence of strokes.
  • Twice as many blood clots in the lungs and leg veins as those taking the placebo.

In contrast, the hormone-treated women

  • 37 percent fewer hip fractures.
  • 34 percent lower rate of colon cancer.

The study found that the frequency of these effects in hormone users did not differ by age, ethnic group or prior health status.