The Hormone Replacement Therapy Controversy

What's a woman to do?...

That's the question many women have been asking given that one of the largest studies of hormone replacement therapy (HRT) ended several years early.

Researchers found that women taking a combination of estrogen and progestin had a greater risk of breast cancer, heart disease, stroke and blood clots than women who did not take synthetic hormones.

The clinical trial involved 16,608 relatively healthy women, aged 50 to 79, who still had a uterus. Researchers followed them for 5.2 years, though the trial was slated for 8.5 years.

The study suggested that if 10,000 postmenopausal women take estrogen along with progestin in a given year, eight more will have invasive breast cancer, seven will have a heart attack, eight will have a stroke and 18 more will have blood clots than women not taking these hormones.

This is not the first study to suggest that a woman's risk of breast cancer rises the longer she is on HRT. In the Oct. 11, 1997 issue of The Lancet, researchers reported a substantial increase in the risk of breast cancer among women — particularly older women — on HRT, and noted that the addition of progesterone — a common form of HRT — failed to reduce that risk.

Hormone Replacement Therapy Risk in Perspective

When the larger HRT study ended this week, many women who take synthetic hormones immediately called their doctors to find out whether they should stop taking HRT for help with menopausal symptoms like hot flashes and night sweats, or to help prevent heart disease.

Discovery Health Online asked several doctors to put the risk in to perspective. Steven Goldstein, professor of obstetrics and gynecology at NYU School of Medicine, said: "First, this study hasn't changed my practice. We've known of breast cancer risk associated with HRT for some time, and we knew that women with heart disease didn't get any benefit from HRT."

But, Goldstein added, "this study never addressed the women who come to menopause with terrible symptoms." Goldstein believes women can still take HRT in the short term, but cautioned that it must be given on a "case-by-case basis. Patients are individuals and should be treated one at a time."

Despite its apparent downsides, HRT has helped thousands of women manage their menopausal symptoms. "Eighty percent of people after three to four years are devoid of symptoms," said Goldstein. "My advice is, after some period, HRT is totally arbitrary. I say we cut it in half and then let's see how the patient feels. If they're miserable and can't function, then we'll go back on something."