Hormone therapy falls out of favor

Pills containing estrogen and progestin have been given to provide women protection against heart disease, as well as respite from hot flashes and other symptoms of menopause. Several studies now indicate no heart benefit and increased risks of circulatory disorders and breast and ovarian cancer, several studies indicate.

Scientists who analyzed data on 16,608 postmenopausal women in a nationwide study report in the July 17 Journal of the American Medical Association (JAMA) that women taking the dual-hormone therapy for 5 years had 26 percent more cases of breast cancer than women receiving an inert pill did. Moreover, compared with the placebo, the hormones doubled the incidence of blood clots, hiked stroke incidence by 41 percent, and upped the occurrence of heart disease by 29 percent.

Although women taking hormones were less likely to get colorectal cancer or to break a hip than were women on the inert pill, the positives of so-called hormone-replacement therapy weren’t enough to offset the negatives, the authors say. Because of that finding, the researchers halted the study.

Earlier this year, researchers at the Fred Hutchinson Cancer Research Center in Seattle also reported a significantly higher breast cancer risk from hormone therapy and cited 28 previous studies linking the drugs to breast cancer. Another study in the July 17 JAMA finds that women on estrogen-only therapy are at greater risk of ovarian cancer than are women not taking the pills.

The apparent failure of hormones to protect the heart also turned up in the U.S.–based Heart and Estrogen/Progestin Replacement Study (HERS). The HERS researchers report in the July 3 JAMA that postmenopausal women with a history of heart disease who received hormone replacement therapy for nearly 7 years had no better heart health than did similar women getting a placebo. Also, dangerous blood clotting in veins was twice as frequent in women receiving hormone treatment than in those receiving a placebo.

Writing in the July 3 JAMA, physician Diana B. Petitti of Kaiser Permanente Southern California in Pasadena says that people are “appropriately pessimistic” about hormone replacement therapy. Nevertheless, they should be heartened by the fact that aspirin, cholesterol-lowering drugs, and other medications remain effective against heart disease and strokes in older women.