O Special Report: What Nobody Tells You About Hormones
The Risks of Hormone Therapy
For many women, the specter of breast cancer is what drives them away from HT—and for those who have a higher-than-average risk of the disease, such fears make sense. The link between HT and breast cancer has been supported by studies in the United States, Sweden, and the United Kingdom.
While finessing the chemistry of estrogen won't likely mitigate the breast cancer risk, tinkering with the progestin component of HT might. "Study after study seems to indicate that the increased risk of breast cancer is not related to estrogen but to progestin," says Steven R. Goldstein, MD, a professor of obstetrics and gynecology at New York University School of Medicine. A separate component of the WHI study in which subjects were not given progestin (because they'd had hysterectomies and stood no risk of uterine cancer) did not show an increase in breast cancer risk.
Goldstein has begun to experiment with prescribing his patients much less progestin, while regularly monitoring their uterine lining with ultrasound—the idea being that a smaller amount of the hormone may be enough to prevent cancer there. Still, he makes clear, "there has been no long-term study of this methodology."
When it comes to heart disease risk, the research is most promising. Because the WHI was designed in part to investigate HT's effect on heart disease, the researchers chose mostly women who were older (and more likely to have cardiac events); the average age of the 27,347 subjects was 63, and a majority of them were at least ten years past having their last menstrual period. But now a new theory has taken shape and steadily gained credibility: that hormones might be less dangerous, and perhaps even beneficial, if started closer to the time women reach menopause (the average age is 51). According to this new theory, estrogen introduced before too much plaque begins to build in a woman's arteries might actually help keep blood vessels healthy. Only after the plaques have gained a foothold might HT make things worse. Further analyses of the WHI data support this idea. As it turns out, a subgroup of younger women in the estrogen-alone study had a significantly reduced risk of heart attacks and cardiac death; those with the increased risk were the ones who'd started hormones more than 10 years beyond menopause.
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