Wellcome Library, London // CC 2.0
The Endocrine Society has released a new, peer-reviewed statement on the risks and benefits of hormone therapy for menopausal women. The upshot is that risks and benefits vary depending on the age of the patient and the length of time since menopause:
One interesting finding . . . was that women who start hormone therapy within 10 years of menopause have a 30% to 40% reduction in total mortality.
In addition, in the 50 to 55 age group the task force concluded that hormone therapy reduced hot flashes and overactive bladder and that vaginal estrogen reduced recurrent urinary tract infections. The evidence also showed that hormone therapy reduced pain on intercourse and improved quality of life.
Given that there are thousands of lawsuits pending over the role of HT in breast cancer, I was especially interested in this nugget of new information:
“Our conclusion is that [the estrogen/progestin hormone combination] didn’t cause breast cancer — it caused preexisting tumors to grow to a size where they became detectable.”
Can we hear something from doctors who aren’t on the payroll of any pharmaceutical
companies? Is this impossible? Why should that be? That is what I want to know.
Reminds me of Paula Derry’s article on how all of the doctors and researchers changed the discourse about WHI so that they could keep prescribing HT….
I found this statement of concern for both procedural and conceptual reasons.
The procedural issues are that the statement was repeatedly made that it was
circulated to all members of the Endocrine Society for comment, yet I am a 25-year
card-carrying member and never saw it. Also, it is not at all clear to me how those
who became part of the writing group were chosen–most have some credibility from
research but all are tending to be supportive or are known advocates of menopausal
hormone therapy. I would guess that there was a concerted effort to exclude those
like myself who have written material that is critical of the reflexive use of
menopausal ovarian hormone therapy.
The conceptual material in this statement is not new. There are two new themes–
testosterone therapy for women’s sexual health, and the closer to menopause (“the
gap”) the woman uses hormones, the higher the risk for breast cancer. The new idea,
and in my view highly questionable, tacit endorsement of the notion that testosterone therapy helps women’s sexual interest, and secondarily quality of life and thus should be taken.
The second new concept is that breast cancer is increased more the closer a woman is to
menopause when she starts hormone therapy. This is written about as “the gap” between
the time of menopause and start of hormone therapy.
So we allegedly have improved cardiovascular health and decreased mortality if we
take hormone therapy in the 10-year “window” closest to menopause. However, if we use
hormones in “the gap” we have increased risk for breast cancer. The obvious answer
for me is that hormone therapy for healthy menopausal women is not a good idea since
menopause with its low estrogen and progesterone (but not low testosterone) levels
is perfectly normal for the life cycle of women.