Nearly five years after government scientists told women that estrogen replacement therapy increased their risks of heart attack and stroke, researchers have largely reversed their position, concluding that the drugs are beneficial for many after all.
Continuing analysis of the original data indicates that the researchers raised a false alarm for most women and that, if women begin taking the hormones shortly after menopause, the drugs do not raise the risk of heart disease and might even lower it.
The latest findings, published in today's New England Journal of Medicine, show that taking estrogen for seven years or more after menopause reduces calcification of the arteries -- a key indicator of atherosclerosis -- by as much as 60%. High levels of calcification are generally considered a predictor of increased heart attack risk.
The only group of women at significant risk from the drugs are those who delay taking them for at least 10 years after menopause, experts said.
The findings "provide some additional reassurance for women who have been denying themselves relief" from hot flashes and other symptoms of menopause, said Dr. JoAnn Manson of Brigham and Women's Hospital in Boston, who led both the original and the latest research.
The research is based on the Women's Health Initiative, a vast federal study launched in the 1990s.
Virtually all researchers agree that women should not fear using estrogen replacement therapy to mitigate menopausal symptoms. The debate is over how long they may safely continue to do so.
Dr. Elizabeth G. Nabel, director of the National Heart, Lung and Blood Institute, which sponsored the research, said the new findings "do not alter the current recommendations that when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible, and hormone therapy should never be used to prevent heart disease."
Dr. Howard N. Hodis, director of USC's Atherosclerosis Research Unit, countered: "There is absolutely no evidence, none, zero, that if you start a woman on estrogen at menopause and continue until she is 80, the risk goes up as she gets older."
There is an increased risk of breast cancer with age for estrogen when combined with progestin, Hodis said at a news conference Tuesday sponsored by Wyeth Pharmaceuticals, and it is not clear whether the risk outweighs the benefits.
