HRT: Another Update
Chester J. Zelasko, Ph.D. | June 10, 2003

The Women's Health Initiative is a federally funded research project started in 1991. There are numerous goals for the project, but the most important thing they want to discover is what women should or should not do to live healthy lives. The problem is that the results from this and other studies have conflicted with previous studies on women's health--especially those related to Hormone Replacement Therapy (HRT). When this type of study is reported in the media, the most sensational parts of the study are typically emphasized. It causes fear and concern, especially if a woman has been using HRT. Better Life Unlimited exists to help make sense out of the health information you hear every day: what was reported, what the researchers think it meant, and what it should mean to you.

Recently, the Women's Health Initiative Memory Study, a subset of subjects enrolled in the Women's Health Initiative, reported that women over 65 years old who use a specific combination of HRT are twice as likely to develop symptoms of dementia even after as little as one year of use. While absolutely true, it has limited value in the everyday world. Why? Because the research showed that 18 women out of 10,000 who use HRT develop symptoms of dementia, compared to 9 women out of 10,000 who use a placebo. That means that the absolute risk of developing dementia is actually quite small--something the researchers state in the paper. But that part didn't make the headlines. Further, they also acknowledge that the results only apply to the specific type of HRT used in the study. Other combinations of HRT may not contribute to dementia.

Most importantly, what does this mean to you? It means that if you take HRT, there is a very small risk that you could develop dementia if you're over 65 years of age when you begin the HRT. Based on other reports from the Women's Health Initiative, you could also have a very small increase in the risk of stroke, heart attack, or breast cancer. The risks are very low, but they are there. Discuss your healthcare needs with your physician on a regular basis, in context with your and your family's health history. He or she should base HRT recommendations on your current levels of estrogen, progesterone, and testosterone. As you age, those levels will change and so should the HRT you require. If there is a message from these studies, that's it: communication between physician and patient.

One final comment. It can be frustrating to hear constantly that the sky is falling, only to be told later it's really not. Prior recommendations for the use of pharmaceuticals to prevent diseases seem to change daily as we learn more about the chronic use of those medications. All parties--researchers, physicians, and consumers--must understand that preventing disease is different from treating disease. Recommending that someone take a medication for the rest of his or her life should not be based only on perceived improvement in the reduction of disease, but also on not causing any harm. Prevention should be for life.

Reference:

  1. Rapp SR, et al. Effect of Estrogen Plus Progestin on Global Cognitive Function in Postmenopausal Women: The Women's Health Initiative Memory Study: A Randomized Controlled Trial. JAMA. 2003; 289(20):2663-72.
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