Home' Trinidad and Tobago Guardian : July 22nd 2013 Contents A36
body & soul
Guardian www.guardian.co.tt Monday, July 22, 2013
Hormone replacement therapy has been a con-
troversial issue for a lot of women over the last
decade. Many have rejected any type of hormone
therapy since a large, federally funded study found
hormone replacement therapy could increase a
woman s risks for heart disease and strokes.
Now, a new study out of Yale School of Medicine
suggests anywhere from 18,000 to 91,000 women
in their 50s who had hysterectomies may have died
prematurely in the last decade because they did not
take estrogen-only hormone replacement therapy.
Before 2002, it was standard practice for gyne-
cologists to recommend estrogen therapy to women
with hysterectomies. More than 90 per cent of those
patients used it to treat symptoms such as hot flashes
and to prevent osteoporosis and other diseases related
to menopausal hormone deficiency. But according
to the Yale study, only about ten per cent of these
women use estrogen therapy today.
The data analysed for this study comes from the
large Women s Health Initiative trial. That study was
designed to confirm the hypotheses that hormone
replacement therapy not only provides relief for
menopause symptoms, but also helps protect women
from heart disease, osteoporosis and dementia. The
WHI first looked at the benefit of taking two hor-
mones, estrogen and progestin, and then examined
the benefits of taking estrogen alone.
The first part of the study was stopped in 2002,
when early results suggested the combined estro-
gen-progestin therapy was actually increasing the
risk of heart disease, stroke, breast cancer and demen-
tia. Researchers saw a sharp decline in overall hormone
use afterward as women heeded their doctors warn-
ings and stopped taking all post-menopausal hor-
mones, whether they had had a hysterectomy or not.
In 2005 and 2012, the US Preventive Services Task
Force recommended against using the combined
therapy or estrogen alone to prevent chronic conditions
in postmenopausal women, which may have deterred
more women from asking their doctors about these
therapies, or stopped doctors from offering it in the
In this new study, published on July 18 in the
American Journal of Public Health, researchers looked
at data from the second portion of the WHI trial,
which looked at estrogen-only therapy.
According to the Yale researchers, the increased
risks discovered in the first part of the WHI study
only applied to women who had not had a hysterec-
tomy and were taking pills that combined estrogen
and progestin. They say the dangers did not apply
to women without a uterus who used estrogen-only
therapy, but few understood the difference.
"Sadly, the media, women, and health care providers
did not appreciate the difference between the two
kinds of hormone therapy," said Dr Philip Sarrel, lead
author of the study and emeritus professor in the
departments of obstetrics, gynecology & reproductive
sciences and psychiatry, at Yale. "As a result, the use
of all forms of FDA-approved menopausal hormone
therapy declined precipitously."
The study noted that results from the second part
of the WHI study were very different.
A series of papers published by the WHI between
2004 and 2012 showed that estrogen-only therapy
had mostly positive health outcomes; they said women
who received estrogen, compared to those who
received a placebo, had fewer deaths each year for
ten years and were less likely to develop breast cancer
and heart disease.
Each year, the death rate among those not taking
estrogen was 13 more per 10,000 women. Most of
those deaths were due to heart disease. This doesn t
need to happen, the study authors say.
"Women need to know that estrogen replacement
is an important part of therapy, especially for women
who are in their 50s and have had a hysterectomy
and their ovaries removed," says Dr Holly Thacker,
director of the Cleveland Clinic Centre for Specialised
Women s Health.
She says it s time for women who have
had hysterectomies to "stop being fearful
of estrogen." She points to other recent
studies that show starting estrogen therapy
shortly after menopause is key to reaping
the benefits of the drugs.
Because each woman s health issues are
different, experts recommend that women
talk to their physicians about estrogen and
other hormone replacement therapy before
they make a decision on whether to take
"Estrogen avoidance has resulted in a
real cost in women s lives every year for
the last ten years, and the deaths continue,"
said Sarrel. "We hope this article will stir
an overdue debate and raise consciousness
about the health benefits of estrogen-only
therapy for women in their 50s with no
YOUR DAILY HEALTH
News and Advice
Estrogen replacement is important especially
for women who are in their 50s. TIME.COM
Estrogen therapy could save lives
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