MEDICATIONS: NEW FACTS ABOUT
ESTROGEN/PROGESTIN HORMONE THERAPY
Choosing whether or not to use post-menopausal hormone therapy is one of the
most important health decisions women face as they age. On July 9, 2002, new
findings were released about the type of postmenopausal hormone therapy that
uses estrogen plus progestin. The findings offer women important new guidance in
considering this type of postmenopausal hormone therapy.
The findings come from the Women's Health Initiative (WHI), a 15-year study
of ways to prevent heart disease, breast and colorectal cancer, and
osteoporosis. WHI, which consists of a set of clinical studies and an
observational study, began in 1991 and involves more than 161,000 healthy
postmenopausal women. WHI is sponsored by the National Heart, Lung and Blood
Institute (NHLBI) in collaboration with other units of the National Institutes
of Health.
One of the clinical studies involved 16,608 women with a uterus who took
either estrogen plus progestin therapy or a placebo (a substance that looks like
the real drug but has no biologic effect). The main goal was to see if the
therapy would help prevent heart disease and hip fractures. Another goal was to
see if those possible benefits were greater than the possible risks for breast
cancer, endometrial cancer and blood clots.
The study was stopped early because after 5.2 years the therapy's risks
outweighed and outnumbered its benefits.
Another WHI study seeks to answer the same questions for estrogen-only
therapy and continues, with results expected in 2005.
Understanding the Results
Results from the estrogen plus progestin study are given in the box. They
show that the therapy did not protect against heart disease but actually
increased heart attacks, stroke and blood clots. It also increased the chance of
breast cancer. It produced some benefits too: It reduced the risk of colorectal
cancer and bone fractures.
It's important to understand that these increased risks apply to an entire
population. Women should not be unduly alarmed by the results. The increased
risk for an individual woman would be small. For instance, each woman in the
study who took the estrogen plus progestin therapy had an increased risk of
breast cancer of less than a tenth of 1 percent per year.
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Study Results
· Estrogen/progestin therapy
resulted in a 26 percent increase in breast cancer, which caused the study
to be stopped. No increase in deaths from breast cancer occurred from the
combined therapy — or in deaths from other causes.
Estrogen/progestin therapy also resulted in:
· 41 percent increase in
strokes
· 29 percent increase in
heart attacks
· Doubled rates of blood
clots in legs and lungs
· 37 percent less colorectal
cancer
· 34 percnet fewer hip
fractures and 24 percent less total
fractures |
Recommendations
The new findings allow the following recommendations for estrogen plus
progestin use:
1. The therapy should not be
continued or started to prevent heart disease. Women should consult their doctor
about other methods of prevention, such as lifestyle changes, and cholesterol-
and blood pressure-lowering drugs.
2. For osteoporosis prevention,
women should consult their doctor and weigh the benefits against their personal
risks for heart attack, stroke, blood clots and breast cancer. Alternate
treatments also are available to prevent osteoporosis and
fractures.
3. Women should keep up with their
regular schedule of mammograms and breast self-examinations.
Finally, while short-term use was not studied, women taking the therapy for
relief of menopausal symptoms may reap more benefits than risks. Women should
talk with their doctor about their personal risks and benefits.
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