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New Analysis Shows Hormone Therapy Safe for Younger Women

April 3, 2007 at 3:40 PM EST
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GWEN IFILL: In 2002, a major study set off public alarm about whether women taking hormone therapy were at higher risk for heart disease, breast cancer, and stroke. Researchers have taken another look at the data now and have new analysis about some of those risks.

Our health correspondent Susan Dentzer joins me now.

Susan, we have talked about this a lot, hormone therapy, good hormone therapy, bad. Where does this report land?

SUSAN DENTZER, NewsHour Health Correspondent: Well, it clears up a lot of concern that arose, as we just said, over the Women’s Health Initiative studies.

When the reports were unveiled in 2002, keep in mind, the Women’s Health Initiative studies were designed to test the proposition that hormone therapy, in addition to being safe and effective to treat menopausal symptoms — so-called hot flashes and night sweats — also had other preventive effects, specifically that they would prevent against heart disease, because there have been some studies that seemed to indicate that.

When the report was made in 2002, it said quite the opposite, that use of these drugs not only didn’t prevent against heart disease, it raised the risk of heart disease, as well as of breast cancer and stroke.

But the question all along was: Is this consistent across the ages that women take these drugs? Because in the Women’s Health Initiative study, there have been women as young as 50 and women close to 80 taking the drugs, so that was one question.

The other was, if you’re just taking the drugs not to prevent anything but just to get through your menopausal symptoms, is that OK? Well, the study that was reported today in the Journal of the American Medical Association really did create some reassurance for younger women. These are women close to 50, or between 50 and 59, and close to menopause.

And the reanalysis, the statistical reanalysis that’s now been done says that, if you’re in that pool, close to 50 or between 50 and 59 and close to menopause, you can take hormone therapy with not any increased risk of heart disease, some increased risk of breast cancer and stroke, but those can be monitored, the study researchers suggested, through mammograms and blood pressure. So the risk of heart disease, again, for younger women doesn’t exist.

No increased heart risk

GWEN IFILL: So it doesn't hurt to take these hormone therapy as far as your heart, but it doesn't necessarily help either?

SUSAN DENTZER: No, and it doesn't help against if you have other risk factors, if you're overweight or whatever. It's not going to protect you against that.

But if you're just weighing the decision -- I've got hot flashes, I've got night sweats, I need some relief by taking these drugs. Is it going to predispose me to more heart attack or stroke? Slight increased risk of stroke. No increased risk of heart attack. No increased risk of heart disease.

GWEN IFILL: And the previous guidance, warnings about cancer, greater evidence of cancer and stroke, that still stands?

SUSAN DENTZER: That still stands. There is still a small but significant increase in breast cancer risk. It's a handful of cases for every 10,000 women, so it's not a huge increase. But it is a big increase when you compare it to the women in the study who were taking dummy pills. There's a substantial difference.

Study's assessment of older women

GWEN IFILL: Now, you're talking about younger women, women on the leading edge of menopausal symptoms. What about older women? Does this report have anything for them?

SUSAN DENTZER: There was one interesting signal in this study about those older women. It looked at these older women between 70 and 79 who were still reporting hot flashes and night sweats; those same women also had greater heart disease risks.

So the researchers now theorize that what's going on for those women is they're having these so-called vasomotor symptoms, but for different reasons that women have them when they go through menopause. Then it's a withdrawal of estrogen and the impact that has on your arteries.

This could be something else. And what they are now suggesting is that women who are 70 to 79, if you're still having hot flashes or night sweats, it's a good reason to go to the doctor and get your other cardiovascular risk factors checked, because probably something else is going on that's much more closely linked to heart disease than it is to the years before when you were going through menopause.

An effective treatment?

GWEN IFILL: In 2002, when this report became public, it began a debate, which I guess will never go away, about the efficacy of hormone treatment in general. Is there any evidence that has emerged in any of these many reports which have come out since that shows that basically hormone replacement -- or hormone therapy, not replacement therapy, hormone therapy is not good for the symptoms, just the symptoms we're talking about?

SUSAN DENTZER: No, it's never been disputed. These drugs have been proven for years to be safe and effective for treatment of menopausal symptoms. But, really, the only issue is, can you mitigate anything else by virtue of using them? And we know, from the 2002 results, that you can't prevent heart disease.

You shouldn't take these to prevent heart disease. You shouldn't take them -- there are some women who will still take them because there is some evidence that it protects against osteoporosis. But the bottom line, certainly from today, is, if you're close to menopause and you have these symptoms, you can take these without worrying about a greater heart disease risk.

A decline in prescriptions

GWEN IFILL: So many people stopped taking hormones after these reports first started coming out. I wonder if doctors now who are involved in reports like this think that maybe the pendulum swung too far?

SUSAN DENTZER: Probably not too far, although you're right. Prescriptions of the two top drugs made by Wyeth, Premarin and Prempro are down two-thirds from 2002. So there's been a huge decline.

And a lot of people feel that this is now the rate of prescription that probably should have been the case all along. These are drugs; they have risks and benefits. You shouldn't take them lightly. You certainly shouldn't take them to prevent things that they now clearly don't prevent, like heart disease.

But if you're using them carefully, for a short period of time -- and, in fact, the information that these drugs have been given for several years to doctors, in the so-called label, says "shortest duration of use, lowest possible dose," a couple of years is really the notion that people think is clearly within the margins of safety. And now we know that that includes no heart disease risk, as well.

GWEN IFILL: OK. Susan Dentzer, thanks again.

SUSAN DENTZER: Thanks, Gwen.