Tags: Hormone | Replacement | Therapy | Safer | Than | Thought

Hormone Replacement Therapy Safer Than Thought

Friday, 16 December 2005 12:00 AM

Here's some key news for menopausal women - the landmark 2002 study showing that hormone replacement therapy raises risks of heart disease and breast cancer may have been totally wrong.

Called the Women's Health Initiative (WHI), the study frightened thousands of women away from taking hormones, but top experts are now saying the work was seriously flawed.

Based on the study's findings, the American Heart Association recommended that long-term hormone therapy not be used for cardiovascular disease prevention and that its use for other reasons be carefully considered.

"Women are now being told not to take hormones for heart disease prevention, and that may be totally wrong," said Dr. Edward Klaiber, a Worcester, Massachusetts endocrinologist.

Dr. Klaiber is the lead author of paper published in the journal Fertility and Sterility, which reevaluates the WHI.

"I looked at the way they designed the study, and they did make some major mistakes," said Dr. Edward L. Klaiber, a consultant endocrinologist at the University of Massachusetts Medical Center.

The WHI found that Prempro - a combination of estrogen and progestin in a daily pill - raised the risk of heart attack, stroke and some forms of cancer.

But Dr. Klaiber says that using Prempro was a bad mistake because at the time of the WHI trial's design, hormone replacement therapy usually involved cyclical progesterone, meaning that it was taken just 10 or 12 days a month.

But daily Prempro was deemed more convenient because patients didn't have to remember which days to take a second pill and because it eliminated a monthly menstrual period, Dr. Klaiber said.

"The results might have been different if they had used a different form of estrogen that resembled a normal cycle," he said.

The WHI study's other major flaw was that participants were older -- the mean age was 62.7 -- and thus at greater risk of cardiovascular problems.

"The incidence of heart disease is 12 times higher for women in their 80s than it is in the 50s," Klaiber said.

As a result, the WHI study began hormone therapy for the first time in women who already had heart disease, and "we know that's not a good idea," he added.

Klaiber believes that earlier studies showing that cyclical hormones are protective against heart disease are probably valid.

"One of the reasons we started giving estrogen to menopausal women was because of the gender differential -- men have a lot more heart attacks and have them earlier," he said.

He is hopeful that a multi-center trial launched last year by the Phoenix-based Kronos Longevity Research Institute will eventually show that hormone replacement therapy is not risky in women who are just beginning to go through menopause.

The Kronos study will treat women age 40 to 55 with hormone pills, hormones delivered through a skin patch, or placebo, but results won't be available until 2010.

Regardless of its flaws, the WHI study was very useful because it showed that "Prempro was a mistake," Klaiber said.

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Here's some key news for menopausal women - the landmark 2002 study showing that hormone replacement therapy raises risks of heart disease and breast cancer may have been totally wrong. Called the Women's Health Initiative (WHI), the study frightened thousands of women...
Hormone,Replacement,Therapy,Safer,Than,Thought
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2005-00-16
Friday, 16 December 2005 12:00 AM
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