Hormone Replacement Therapy

Study findings on use of hormone replacement therapy include increased risk for heart attack, stroke and blood clots:

• Heart attack. For heart attack, the risk (from using Hormone Replacement Therapy) began to increase in the first year of estrogen plus progestin use and became more pronounced in the second year. After 5.2 years, there were 29 percent more heart attacks in the estrogen plus progestin group than in the placebo group–or 7 more heart attacks each year for every 10,000 women.
• Note: there are some alternatives to hormone therapy that will also reduce your risk of heart disease:
• Lifestyle behaviors, including:
• Following a healthy eating plan
• Limiting consumption of alcoholic beverages
• Not smoking
• Maintaining a healthy weight
• Being physically active
• Preventing and controlling high blood pressure
• Preventing and controlling high blood cholesterol
• Managing diabetes
• Taking prescribed medication to control heart disease
• Stroke. For the first time, estrogen plus progestin was shown to cause more strokes in healthy women. By the end of the study, the estrogen plus progestin group had 41 percent more strokes than the placebo group–or 8 more strokes each year for every 10,000 women.
• Blood clots. The risk of total blood clots was greatest during the first 2 years of hormone use–four times higher than that of placebo users. By the end of the study, it had decreased to two times greater–or 18 more women with blood clots each year for every 10,000 women.

A 41 percent increase in strokes vs a 34 percent decline in hip fractures. Which is more important? The bad news, or the good? How can you sort through the benefits and risks and make a good decision about whether or not to use postmenopausal hormone therapy? Here are several points to help you evaluate the findings:

Points to consider:

• First, it's important to know that, because the study involved healthy women, only a small number of them had either a negative or positive effect from estrogen plus progestin therapy.
• The percentages describe what would happen to a whole population–not to an individual woman. For example, the increased risk of breast cancer for the women in the WHI study who were taking the estrogen plus progestin therapy was less than a tenth of 1 percent each year.
• Remember too that reports of increased risks do not mean you will develop breast cancer or another condition if you have been using the hormone therapy. Your personal and family medical history, along with your lifestyle and other influences, play a big role in your chance of developing a disease.
• However, if you apply that increased risk to a large group of women and over several years, then the number of women affected becomes an important public health concern. As noted, about 6 million American women take estrogen plus progestin therapy. That would translate into nearly 6,000 more cases of breast cancer every year– and, if all of the women took the therapy for 5 years, that might result in 30,000 more cases of breast cancer.
• If you count up all the added cases of breast cancer, heart attacks, strokes, and blood clots in the lungs and subtract the fewer cases of colorectal cancer and hip fractures, you'd still get about 100 extra harmful events among the 10,000 hormone users after 5.2 years–the period the study ran. Multiply that by 10 years and millions of women and the number of cases of adverse effects grows.

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