Researchers stress view: HRT should be restricted -
Workshop served to clear up confusion on study of treatment.
an international meeting last week, the authors of the
most comprehensive study to date on hormone replacement
therapy made crystal clear their view that use of the
medical treatment should be severely restricted.
Controversy over HRT arose when a large U.S. study of
Prempro, the most popular estrogen-progestin combination
hormone treatment, was halted in July five years after
it began. Researchers and doctors met at a two-day workshop
organized by the National Institutes of Health in Bethesda,
Md., to discuss the future of HRT.
Investigators with the study, known as the Women's Health
Initiative (WHI) study, found that Prempro raised slightly
the risk of heart attacks, strokes, blood clots and
breast cancer that were not balanced by its benefits
— slight decreases in hip fractures and colon cancer.
individual women, the risks are small: For every 10,000
women who took the pills for a year, there were eight
more breast cancers, eight more strokes and seven more
heart attacks compared to 10,000 women who didn't. However,
when you multiply those figures by the millions of women
worldwide who take these hormones, there are tens of
thousands of additional cases of heart attack, stroke,
breast cancer and pulmonary embolism linked to HRT.
if you are a woman who ends up in a wheelchair for the
rest of your life because of a stroke or dies prematurely
after suffering a heart attack, for you the risk is
100 per cent, cautioned Women's Health Initiative co-investigator
Dr. Susan Hendrix of Wayne State University. "It's
all or nothing," she said. Keep in mind this
was no ordinary study, but gold-standard research.
It was a large randomized, double-blind controlled trial
of 16,000 women aged 50 to 79. Half the women
took HRT, while the other half got a placebo, though
neither the women nor the researchers knew which group
was which until the trial ended.
Many doctors at the meeting in Bethesda criticized the
study's design and said the investigators did a disservice
to millions of women. Critics said there are quality
of life issues involved, because without hormones many
women will suffer hot flashes, vaginal dryness and night
National Institutes of Health director Dr. Elias Zerhouni
said: "The reaction to a new scientific finding
is really in proportion to the dogma it is upending."
had a strong dogma" about HRT, he added, so perhaps
it's not surprising that reaction was swift and heated.
Researchers are currently doing further analyses on
the massive amount of data collected in the study to
better differentiate the risks of HRT and ultimately
help women decide whether to take it.
These analyses will look at a host of factors such as
age, body mass index, ethnicity and prior hormone use,
to determine how they affect the risk of taking HRT.
The hormones' effect on quality of life will also be
women in the study will be followed up for three years
to see whether the risks and benefits of HRT persist,
and also to evaluate the effect of stopping hormone
results of those analyses are expected in the next six
to nine months.
the meantime, it's best to take a conservative approach
to HRT, advised the study investigators.Unequivocally,
HRT should no longer be used to treat or prevent heart
has been shown to reduce the risk of hip fractures,
which are one of the leading causes of disability and
death in older women. There are alternatives to prevent
bone loss, such as bisphosphonates. But for the one
in 10 women who can't tolerate them and are at significant
risk of osteoporosis, HRT may make sense.
to the investigators, the only real indicated use for
HRT now is in women with severe, debilitating menopausal
symptoms, which is the only use for which it is approved
by the U.S. Food and Drug Administration.
even in these cases, HRT should be used in the lowest
dose possible for the shortest duration necessary to