A major clinical trial of 16,000 women that was set to continue until 2005 is over early so that women can be alerted about an unexpected outcome. Millions of women take hormone therapy to relieve menopausal symptoms, or to prevent chronic conditions like heart disease or osteoporosis. Now researchers say it looks like long term use of Estrogen plus Progestin may instead be increasing the risk of invasive breast cancer, strokes, and heart attacks in women. The stop testing order comes from the National Heart, Lung and Blood Institute of the National Institutes of Health. So, what do you do now if you are one of the millions on that combined therapy? The answer from Dr. Isaac Schiff, Chief of Ob-Gyn at Massachusetts General Hospital.
"Although this study shed further light on the risks which many of us were aware of for sometime, keep in mind that some women will continue to take Estrogens because they just feel better on hormone replacement therapy and that's not wrong as long as they're aware of the risks. I would recommend that the patient call her healthcare provider and determine why she's on Estrogens in the first place. If she's taking Estrogens for relief of her symptoms she and her healthcare provider ought to determine how she could come off the Estrogens over what period of time that would be in her best interest. If you're using Estrogens to prevent osteoporosis, at some point you should be coming off Estrogens and should consider taking some of the other medications which have not been shown to increase the risks for breast cancer. If you're taking them to prevent heart disease there is no reason to continue using Estrogens at this point. If a woman has severe hot flashes finds relief with hormone replacement therapy but now wants to stop she ought to wean slowly over time. It may take three months, it may take six months. If one stops the estrogens abruptly, the hot flashes may come back as severely as the day she first started the Estrogens," says Dr. Schiff.
So, talk to your doctor, but the NIH says there is no reason to panic over this. That many women may still choose to use the hormones for short periods to treat the symptoms of menopause. The concern is over long term, meaning more than four years of combined hormonal therapy.
As reported in the Journal of the American Medical Association, Dr. Jacques Rossouw of the National Heart, Lung and Blood Institute and the Women's Health Initiative, led a randomized, controlled clinical study of more than 16,000 healthy women between the ages of 50 and 79. They were given either a placebo or combination therapy of Estrogen plus Progestin, a combination known to prevent endometrial cancer of the uterus, which is a risk from taking Estrogen alone. The trial was intended to last eight and a half years, but was stopped shortly after five years because of the increased risk of breast cancer. The study also shows an increased risk of heart disease, strokes, and blood clots in the legs and lungs from the combination hormone. The study did show a reduction in hip fractures and a reduction in colorectal cancer, but researchers say in this case, the risks of long-term use are far greater than the benefits.
Dr. Margery Gass, Ob-Gyn and President Elect of the North American Menopause Society says, "Short-term therapy would be anywhere from one to four years. We think the risks are fairly low at that point. But I still think it prudent for a woman to review all of these risks and benefits in making that decision and to review those with her clinician."
This study only involved women who still had their uterus. A separate study of Estrogen in those who have had a hysterectomy is still ongoing with no clear balance in the risks or benefits in those women. For more information, you can (click here).