Hormone Treatment in Older Women Questioned
By Susan Okie

In older women, taking the sex hormones oestrogen and progestin does not improve emotional well-being except among those suffering from hot flushes, a new study suggests. In women without hot flushes, the hormones may actually worsen physical functioning.

The researchers called the results surprising and said they cast doubt on the popular belief, encouraged by drug advertisements, that taking hormones after menopause can make most women feel more youthful, active and vibrant.

"These findings are challenging that perception," said Joann E. Manson, chief of preventive medicine at Harvard's Brigham and Women Hospital. "This study would suggest that perhaps we should remove quality-of-life benefits from the risk/benefit equation" when women are considering whether to take hormones after menopause.

Thirty-eight percent of U.S. women between the ages of 50 and 74 take hormones after menopause, according to a national survey published in 1999. However, the new findings are the latest in an array of studies that have raised questions about whether such treatment confers a net health benefit.

For example, oestrogen increases the risk of blood clots, gall bladder disease, uterine cancer and breast cancer.

Manson and other experts emphasized that the new study confirmed that women suffering from frequent hot flushes do obtain relief from hormone treatment. Hot flushes - sudden episodes of skin flushing, sweating and a sensation of uncomfortable warmth - occur in 70 percent of women during menopause and are sometimes severe enough to cause insomnia, fatigue and irritability.

In some women they abate after a year or two, while in others they continue for a decade or more. Among study participants with hot flushes, hormone treatment improved symptoms of depression and did not reduce physical well-being.

The new study, led by cardiologist Mark A. Hlatky of Stanford University, examined physical functioning, energy levels, mental health and depressive symptoms among 2,763 women who participated in the HERS trial, a research project originally designed to find out whether women with heart disease would benefit from treatment with oestrogen and progestin.

Women in the study were randomly allocated to receive either hormone treatment or a placebo. Researchers then followed their health for three years.

In the group as a whole, physical functioning, energy and mental health declined during the study, perhaps reflecting their underlying heart disease. However, at the start of the study, 16 percent of the women said they were bothered by hot flushes, and their baseline indicators of physical and mental health were worse than for the other participants.

Among this group, hormone treatment improved depression and mental health without significantly affecting energy levels or physical functioning.

In contrast, women without hot flushes who received hormone treatment showed a faster decline in physical functioning than women given a placebo, but no significant difference in mental health or symptoms of depression.
Washington Post February 5, 2002
JAMA February 6, 2002:287:591-97

CTM Comment: Excess estrogen in the female body, unopposed by progesterone, may bring on menopausal symptoms, cysts, fibroids and breast cancer. There is a tremendous controversy raging over the necessity of hysterectomies, ovary removal, HRT treatments and the dangers associated with these procedures. For a fuller explanation, the reader should read "Barking up the Wrong Tree", a chapter devoted to these issues in Health Wars (www.credence.org).