Currently, hormone replacement therapy (HRT) at the time of the menopause is subject to much controversy. According to a new study by researchers at Yale University, misconceptions about the risks of estrogen therapy have led to the premature deaths of nearly 50,000 women over the past 10 years. The findings were published online on July 18 in the American Journal of Public Health.
The researchers examined the effect of estrogen avoidance on mortality rates among women aged 50 to 59 years who had undergone a hysterectomy. Before 2002, more than 90% of women who underwent a hysterectomy were treated with some type of hormone therapy, to help manage symptoms related to early menopause caused by the operation. In 2002, however, a Women’s Health Initiative (WHI) study suggested that combination estrogen-progesterone treatments could potentially increase women’s risk for cancer and other health issues. In the 10 years after that study was published, the numbers of women choosing to receive any type of hormone treatment post-hysterectomy dropped dramatically.
The researchers reviewed data from the WHI and developed a formula to determine if excess mortality occurred among women aged 50 to 59 years who had undergone a hysterectomy. The women who did not receive HRT were compared to the entire population of comparable women in the United States. The investigators incorporated the decline in estrogen use observed between 2002 and 2011. They found that over a 10-year span, beginning in 2002, a minimum of 18,601 and as many as 91,610 postmenopausal women died prematurely because of the avoidance of HRT.
The authors concluded that HRT in younger postmenopausal women is associated with a decisive reduction in all-cause mortality; however, estrogen use in this population is low and continuing to fall. They noted that their data indicated an associated annual mortality toll in the thousands of women aged 50 to 59 years. They recommended that informed discussion between these women and their healthcare providers about the effects of HRT is a matter of considerable urgency.
Take home message:
A number of studies have noted that HRT therapy begun at the onset of menopause or immediately following a hysterectomy has more benefits and is less detrimental than starting hormonal replacement sometime later. Also, in the past, many women took oral HRT, Premarin being the most popular. Now low-dose estrogen patches are available that release estrogen directly into the blood stream. If you are premenopausal and have been recommended to undergo a hysterectomy or are approaching the menopause, have a thorough discussion regarding HRT with your healthcare provider (gynecologist). Be aware that, currently, a number of physicians are reluctant to prescribe HRT because of legal repercussions if the patient subsequently develops breast or uterine cancer and deems the HRT to be responsible. As with any medical therapy, benefits vs. risks must be carefully weighed.