Hormone Therapy Without Menopause Symptoms Discouraged
(WASHINGTON) -- The U.S. government renewed its recommendation against prescribing hormone therapy to postmenopausal women for the prevention of chronic conditions like heart disease and bone loss, but didn't tackle whether women should take hormones to relieve their hot flashes and night sweats.
"The evidence shows that the harms of hormone therapy for the prevention of chronic conditions outweigh the benefits, which is what the evidence also showed in 2005," said Dr. Kirsten Bibbins-Domingo, a member of the Task Force. The task force only looks at preventative medicine and would not typically make a recommendation regarding whether women should use hormone therapy to relieve their menopause symptoms.
Since doctors haven't regularly prescribed hormones for chronic disease prevention since 2002 study findings showed the dangers of long-term hormone therapy, some doctors are worried patients will be confused by the Task Force recommendation.
"At the present time, the pendulum has already swung away from the use of hormone therapy for chronic disease prevention," said Dr. JoAnn Manson, chief of preventative medicine at Brigham and Women's Hospital in Boston. "Recently, the consensus of the 15 top medical societies saying hormone therapy still has an important clinical role in management of night sweats and other menopause symptoms."
Like birth control and other drugs, hormone therapy comes with a set of risks, Manson said. As such, doctors should not prescribe them if they outweigh the benefits for a particular patient. If the patient has no symptoms, which would be the case if she is taking hormone therapy simply for "chronic disease prevention," the risks do not outweigh the benefits.
Two hormone therapy studies came out within a week of each other this month, generating excitement in the medical community because they showed positive results of using short-term hormone therapy for women who start it shortly after their last menstrual period: the Kronos Early Estrogen Prevention Study nicknamed KEEPS, and a Danish study.
However, the Task Force did not consider either of them because they were not available when it was making its decision, Bibbons-Domingo said.
"In the context of the larger body of evidence the Task Force considered when making this recommendation, it is unlikely that this study would have altered the balance of harms versus benefits and led the Task Force to a different recommendation," Bibbons-Domingo said.
According to the review published in the Annals of Internal Medicine, researchers looked at studies from 2002 forward and chose nine on which to base the Task Force recommendation. They found that estrogen and progestin reduced bone fractures but increased invasive breast cancer stroke and other ailments.
The first study to raise the alarm on hormone therapy was the Women's Health Initiative, or WHI, which stopped prescribing hormone pills to its 160,000 participants between the ages of 50 and 79 in 2002, the year it found that the hormones made women more likely to develop aggressive breast cancer. The participants has been taking the pills for 10 years because doctors believed the pills would prevent chronic diseases. Follow-ups continued through 2010.
This study was included in the Task Force's recommendation, but Dr. Katherine Sherif, director of the Drexel Center for Women's Health, said the WHI was misleading because its participants were 10 years older than most hormone therapy patients today.
"I've been in this business for 17 years, and no woman who is 63 has ever said to me, 'I need hormones for hot flashes,'" Sherif said, adding that most of her patients are in their late 40s or early 50s. "It irritates me that people keep falling back on the Women's Health Initiative in that hormones are dangerous for women. It just isn't that clear cut."
This month, KEEPS followed 727 women ages 42 to 58 (much younger than WHI) for four years, but researchers didn't have enough time to study long term health outcomes like cancer, heart disease and death. As such, they looked for risk factors, and found that hormone pills made no difference. KEEPS has yet to publish its data.
The following week, researchers at Hvidovre Hospital in Denmark announced that they'd found proof of the timing hypothesis, which suggests that hormone therapy protects women from heart disease if they start it soon after their last menstrual period. It looked at 1,000 women ages 45 to 58 over 16 years. Researchers also found that fewer women on hormone therapy were diagnosed with breast cancer, but the figure wasn't statistically significant. As such, they concluded hormone therapy did not increase breast cancer risk.
Manson said more research is needed on lower doses of hormone therapy for menopause symptom relief.
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