Following a 2002 study by the Women’s Health Initiative (WHI), a randomized clinical trial sponsored by the National Heart, Lung, and Blood Institute that tied hormone replacement therapy to an increased risk for heart disease and stroke, many women avoided hormone therapy altogether. The WHI trials examined only synthetically-derived hormones delivered in pill form. Shufelt and a team of investigators at the Barbra Streisand Women’s Heart Center, Harvard Medical School, and other WHI clinical centers reviewed the scientific data collected by the Women’s Health Initiative on 93,000 post-menopausal women and tracked their use of hormone therapy, along with their health outcomes. Results have been published on the website of the medical journal Menopause and will appear in the March 2014 print edition.
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Hormone therapy risks may vary by weight, other factors
To investigate further, Huo and his team analyzed data from the National Cancer Institute’s Breast Cancer Surveillance Consortium, which includes 1,642,824 screening mammograms and 9,300 breast cancer cases. In their analysis, they looked at women 45 years old and older and considered the women’s ethnicity and BMI, as well as their breast density. Greater breast density means a woman has more breast tissue and connective tissue than fatty tissue, while lower density means she has more fatty tissue relative to breast and connective tissue. Women with extremely dense breasts, who represent about 15 percent of the general female population, are known to have a greater risk of breast cancer. The researchers found that HRT use was linked with an increased risk of cancer for white, Asian and Hispanic women, but not for black women. The highest risk was seen for women with normal to low BMI and extremely dense breasts, who were 49 percent more likely to develop breast cancer on HRT than women with the same traits not taking HRT.
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Hormone therapy, calcium may lower fracture risk
However, the combination treatment had no effect on women’s bone mineral density – a reflection of osteoporosis and fracture risk, Wactawski-Wende and her team reported in the journal Menopause. Some previous studies have suggested that vitamin D may protect against fractures less by strengthening bones than by improving muscle strength and thereby reducing falls, but others have not found the same effect. Hormone therapy has become less common since WHI data linked hormone use to heart disease, stroke and breast cancer, though it’s still considered the most effective treatment for some symptoms of menopause, such as hot flashes. Curtis, who wasn’t involved in the new research, said she thinks the pendulum initially swung too far away from hormone therapy, and that doctors are coming to realize it may still help some women. “I think ultimately people have become aware that maybe it’s not the placebo for getting older that some may have perceived it was being marketed as, but that maybe there are benefits for it,” she told Reuters Health. Because of the risks, women shouldn’t take hormone therapy just to prevent fractures, Wactawski-Wende said. “The major indication for taking hormone therapy is for management of moderate to severe menopausal symptoms,” she told Reuters Health.
For the original version including any supplementary images or video, visit http://www.reuters.com/article/2013/06/28/us-hormone-therapy-idUSBRE95R0YN20130628