Older Women Should Avoid Hormone Therapy

CHICAGO - Women long past menopause should not use hormones to prevent heart disease, researchers said.

But mounting evidence suggests hormone therapy may be useful for women early in menopause looking for short-term relief from hot flashes and other menopausal symptoms, another researcher said.

The international study on older women, published in the British Medical Journal, confirms recent findings that suggest hormone replacement therapy or HRT poses risks for women in their sixties just starting to take it.

"For long-term prevention of chronic diseases, hormone therapy would really not be advisable," said Dr. JoAnn Manson, chief of the division of preventive medicine at Harvard Medical School's Brigham and Women's Hospital in Boston.

Manson, who was not involved in the British Medical Journal study, spoke separately at a news briefing on the latest thinking about hormone replacement therapy.

For many years, doctors had thought hormone therapy could protect women from chronic diseases and especially from heart disease.

But a 2002 study called the Women's Health Initiative or WHI raised alarms about heart attack and stroke risks associated with the therapy, leading millions of women to abandon HRT.

Now growing evidence suggests these risks are most pronounced for women who start taking hormones later.

The latest study, initiated by the UK Medical Research Council, looked at 5,692 women in Britain, Australia and New Zealand with an average age of 63 who were about 15 years past menopause.

 

HEART BENEFIT STUDIED

The trial started in 1999 and was stopped after the WHI results were released. The findings show no overall disease prevention benefit and an increase in chest pain, heart attacks and blood clots for older women just starting HRT treatment.

Manson, a member of the Women's Health Initiative Steering Committee, said the international study -- dubbed WISDOM -- was relatively small compared to the WHI study.

A new analysis of the WHI study in April suggested younger women may be able to safely take HRT if they start treatment within 10 years of menopause.

And a study in the New England Journal of Medicine last month suggested estrogen might protect younger women who just entered menopause from heart disease.

Now the WISDOM study concludes that older women do not get a heart benefit. "Hormone therapy should not be used for prevention of cardiovascular disease," Manson said.

But she said HRT appears to be a reasonable choice for a recently menopausal woman who has hot flashes and night sweats that interfere with sleep and disrupt quality of life.

Manson recommends the lowest effective dose for the shortest duration necessary because longer-term use of HRT raises the risk of breast cancer.

"Many women can get by with only three to four years of treatment, where breast cancer would not be as great a factor in the benefit-risk equation."

For women with known heart problems, HRT should not be used, she said.

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