Menopausal Muddle

Fifty Thousand deaths. That’s the toll Yale University researchers attribute to accurate but incomplete news about the dangers of hormone-replacement therapy (HRT) for postmenopausal women. As a result of that news, a subset of women who could have benefited from HRT avoided it, with fatal consequences.

The harms of HRT were widely broadcast in 2002 after the Women’s Health Initiative (WHI) found that the combination of estrogen and progestin prescribed to women about 10 years after menopause to protect them from heart disease actually increased their risk of heart problems and breast cancer. In an about-face, doctors and women alike shunned HRT to treat hot flashes and other menopausal symptoms, whatever a patient’s age.

But women ages 50 to 59 who had had hysterectomies might have benefited from estrogen alone. (They don’t need progestin to protect against uterine tumors, which estrogen can trigger.) Before the WHI trial, say the Yale scientists, nearly 90% of such women took estrogen to replace what their bodies no longer made; only 10% did so after 2002. Those who did not may have lost some of the heart protection that estrogen can provide.

The conclusion that HRT was universally harmful meant that distinctions between age groups got lost. “We tend to simplify and come up with a one-size-fits-all answer,” says Dr. JoAnn Manson, chief of preventive medicine at Brigham & Women’s Hospital and a WHI investigator.

Even the news linking 50,000 deaths to the WHI effect may be an oversimplification. So WHI investigators are taking a closer look at how estrogen and progestin as well as estrogen alone can affect women’s health at different ages. That could lead to more individualized guidelines about who can safely undergo HRT and when.