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Is age the key?


Replacement therapy doesn't harm the heart when women are young, scientists find. In fact, it might even help.

July 23, 2007|Shari Roan and Times Staff Writer

HORMONES seemed like the answer for Nancy Adams when hot flashes began disrupting her sleep seven years ago. The little pill that she got from her doctor solved the night sweat problem and she slept like a baby once again.

All went well -- "until," the L.A. resident says, "the study came out."

"The" study 58-year-old Adams is talking about was part of the landmark Women's Health Initiative that tracked 16,608 women and rocked doctors and patients alike in 2002 with the news that women taking estrogen and progestin had a higher risk of heart attacks, strokes and breast cancer than women who didn't take hormones.

"It terrified me and everybody else," Adams says.

An estimated 15 million U.S. women were taking hormones at the time, and within a year more than 40% of them, Adams included, quit cold turkey. In Adams' case, it was only for a while. Her hot flashes faded, but other bothersome symptoms -- vaginal dryness and the frequent urge to urinate -- cropped up. After dealing with this duo for some months, she opted for the hormones once again.

"I still have concerns about using hormone replacement therapy -- the increased risk of heart attacks, stroke, breast cancer, all those things," she says. "The doctors are still learning about what the effects are, and we are helping them learn. And that is frustrating."

But for women like Adams -- those younger than 60 who have troublesome menopausal symptoms -- hormone therapy has recently been given something of a reprieve. A new analysis of the Women's Health Initiative data suggests that the hormone story is actually two stories -- one for women near the age of menopause and one for women age 60 and older who are a decade past that life change.

For older women, the story appears to be written: Hormones aren't for you.

For younger women who are bothered by menopausal symptoms, the story is more encouraging. Hormones may be a lot kinder to the heart than scientists said back in 2002 when directors of the Women's Health Initiative announced that the risk of heart attack, stroke and breast cancer was increased in women "irrespective of age."

Stroke risk is slightly increased for all women on hormones, and breast cancer risk is slightly elevated in women taking estrogen plus progestin. But the risk of heart attack does not, after all, appear raised in younger women -- and may even be lower.

Especially in light of these new data, many doctors and scientists think the wide-scale tossing away of hormone pills five years ago was an overreaction and that many who could have been helped suffered needlessly.

Some things haven't changed. Very few doctors today would suggest women take hormones for anything other than moderate to severe menopausal symptoms -- and only for a few years, at that. And there are nuances to the hormone decision based on a woman's health, family history and personal lifestyle.


No fountain of youth

Despite the uproar and confusion it caused, the Women's Health Initiative revealed important facts, experts say. It reversed a popular theory permeating women's health in the late 1990s that hormones benefited every woman. This so-called "forever young" hypothesis suggested that hormones would stave off heart disease, osteoporosis and dementia and keep women looking and feeling young well into old age.

Instead, the study showed that, except for controlling menopausal symptoms and helping prevent osteoporosis, hormones appear to have few preventive benefits for the average woman in the study.

But that average woman was 63 -- far past the age when most women go through menopause.

Because of the age of the women in the group, many scientists and doctors have maintained that the 2002 WHI announcement may have done younger menopausal women -- particularly those who suffer severe menopausal symptoms, such as hot flashes, night sweats and vaginal dryness -- a disservice. Two recent studies analyzing data of younger women in the Women's Health Initiative, with an average age of 55, suggests a different risk-benefit profile.

One study, published in April in the Journal of the American Medical Assn., reported that although the risk of heart attacks is increased in those who initiate therapy more than 10 years after menopause, the risk is not increased in women who start hormones less than 10 years after. This analysis of more than 27,000 women combined data from the women in the study who took only estrogen with those who took both estrogen and progestin. It found the risk of stroke was higher for all ages but the risk of death from any cause was lower in women who were 50 to 59 when they started taking hormones, either estrogen alone or estrogen with progestin.

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