By Susan Okie
In older women, taking the sex hormones estrogen and progestin does not improve emotional well-being except among those suffering from hot flashes, a new study suggests. In women without hot flashes, 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, estrogen 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 flashes do obtain relief from hormone treatment. Hot flashes - 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 flashes, 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 estrogen 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 flashes, 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 flashes 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
Unless you had your head buried under the sand for the last few years, you should be aware that excess estrogen is one of the main causes of breast cancer.
The key here is excess. Women do need estrogen. The problem is that most western women have excessive amounts. Many women also have total hysterectomies in which their ovaries are removed. This is one of the few times where estrogen replacement therapy is appropriate.
Unfortunately, the above study was quite small and did not seem to differentiate between these two groups.
However, in addition to estrogen increasing the risk of breast cancer, the study shows it increases insulin levels.
This is important, since increased insulin levels are associated with not only increased risk of cancer, but high blood pressure, diabetes, high cholesterol and obesity.
Estrogen has also been promoted for many years to decrease the risk of heart disease. Well folks, this is simply not true.
Although estrogen does appear to lower cholesterol levels, heart disease prevention is clearly far more complex than cholesterol levels alone. It seems quite clear that estrogen supplementation, in postmenopausal women who still have their ovaries, does not lower the risk of heart disease.
Additionally, estrogen is not the cure for bone loss that it is commonly promoted to be, and estrogen does not decrease a women's risk of Alzheimer's disease.
It is interesting to note that the study found that women who did not benefit from the hot flash improvement, actually did worse when put on hormone replacement, than women who did not take anything.
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Hormone Replacement Does Not Slow Alzheimer's Another Study Links HRT to Breast Cancer Risk
Hormone Replacement Does Not Slow Alzheimer's
Another Study Links HRT to Breast Cancer Risk