Estrogen Could Save Lives

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For more than a decade, doctors have cautioned women about the risks associated with hormone replacement therapy. But those warnings may have put one group of women at increased risk of dying early, according to the latest study.

Researchers at Yale University say that nearly 50,000 women may have died prematurely after they stopped taking hormone replacement therapy (HRT) to treat menopause symptoms, following a much-publicized 2002 study that revealed the treatment increased risk of heart disease and breast cancer.

The 2002 Womens Health Initiative(WHI) study, a 15 year investigation into the factors that contribute to the health of post menopausal women, was stopped three years early when a preliminary review of the data showed that women taking the combination of estrogen and progestin had a higher rate of breast cancer, heart disease and stroke than women taking a placebo. The results stunned both the public and the medical community, since doctors had been prescribing the hormones not just to treat menopausal symptoms such as hot flashes, but for extended periods of time to protect women against heart disease.

Almost immediately, doctors and public health officials began shifting women away from such long term use of hormones, recommending that post-menopausal women restrict hormone use to the few months surrounding menopause to address the most intense symptoms. In 2012, the United States Preventive Services Task Force confirmed the WHI trials findings, concluding after a review of 51 studies published since 2002 that the risks of HRT outweighed the benefits, which were limited to a reduced risk of fractures.

But the WHI scientists had always cautioned that their findings might not be broadly applicable to all women past menopause. They noted that the trial included women who were at least a decade beyond menopause, and that the participants used one specific formulation of HRT calledPrempro, which is a combination of conjugated estrogens and a synthetic form of progesterone known as medroxy-progesterone acetate.

MORE: The Truth About Hormones

The WHI also continued to evaluate women who had had a hysterectomy, and therefore could take estrogen alone; women with an intact uterus are not advised to take estrogen without the protective effect of progesterone since estrogen is linked to a higher risk of uterine cancer. In 2007, the WHI reported that women with a hysterectomy who took estrogen alone had fewer calcium-based plaques in their arteries, and therefore may have enjoyed some protection against heart disease. This finding was supported by a 2011 study published in the Journal of the American Medical Association (JAMA) that found a slightly lower risk of breast cancer and no significantly increased risk of heart disease, blood clots, stroke or early death among women taking estrogen only compared to women with hysterectomies who took a placebo.

Based on those results, the Yale scientists decided to study this group of women further, to determine whether widespread coverage about the risks of HRT the combination of estrogen and progestin had convinced these women to stop taking their estrogen-only therapy, and whether that decision impacted their mortality. Could women without a uterus benefit in some way from estrogen-only therapy, and were they putting their health at risk if they avoided the hormone therapy?

Their analysis, published in the American Journal of Public Health, confirmed their suspicions. Before the WHI study, about 90% of women who had a hysterectomy would have relied on estrogen therapy to replace what their reproductive system no longer produced. Following WHI, however, 10% of these women used the hormone, and based on a formula the researchers created to estimate their survival rates, they determined that 50,000 women died during the study period, between 2002 and 2011, prematurely. Dr. Philip Sarrel, emeritus professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and lead author of the study, said in a video discussing the study that none of these women, who were aged 50 to 59 at the start of the study, lived to reach their 70s. Most died of heart disease, bolstering the connection that earlier studies had found between estrogen-only therapy and a lower risk of heart problems among women who had a hysterectomy.

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Estrogen Could Save Lives