Benefits Of Estrogen Shouldn't Be Overlooked, USC Physician Says

Main Category: Menopause
Also Included In: Cardiovascular / Cardiology;  Endocrinology
Article Date: 17 Feb 2006 - 21:00 PST

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Results released this week from the Women's Health Initiative (WHI) trial clarifies estrogen's role in protecting women from heart attacks. A USC medical researcher encourages women and doctors not to dismiss hormone therapy as the research continues to sort out mixed results from the last few years.

"It remains a very active area for women's research - it's a very unsettled area, and the trials to date show differing outcomes," says Howard N. Hodis, MD, director of the atherosclerosis research unit in the Keck School of Medicine of USC. In the meantime, women can still find benefits from taking hormones, including the relief of menopausal symptoms, preserving bone density and reducing risk of diabetes, even if their long-term benefits and risks are still being clarified.

"Are there risks? Yes, like any other medication, but they're not great enough to create panic and make everyone using hormones get off them," he says.

An article published in the Feb. 13 issue of the Archives of Internal Medicine concludes that estrogen therapy does not appear to raise or reduce the risk of heart attack in healthy postmenopausal women overall, but it does appear to lower the risk of heart disease in women aged 50 to 59 years. These results are consistent with a previous trial conducted at USC and dozens of previous observational studies conducted over several decades, Hodis says.

However, the popularity of hormone replacement therapy dropped dramatically after a WHI study of estrogen-only therapy was cut short in 2003 when it appeared to increase the risk of stroke in women aged 50 to 79 who had had hysterectomies. After that study, much of the other data that showed a benefit was set aside, and women were advised to avoid hormone replacement therapy - a recommendation that Hodis says was unnecessary.

One problem with ruling out estrogen for everyone based on the WHI study, as some doctors have done, is that the findings aren't the same for women of different ages and risk groups.

"To get a cardiovascular benefit, it appears that hormone therapy may need to be started within six years of menopause, and continued for 10 or more years, a theory that we are currently studying," Hodis says. "So women who have recently experienced menopause and starting taking estrogen right away may derive the most benefit."

Other trials of an estrogen-progestin combination therapy, including a WHI trial, have found that it reduces the risk of developing diabetes by up to 30 percent. It remains to be seen if estrogen alone has this same benefit, he says.

Hodis is among those participating in the effort to clarify the benefits of hormones. He is leading the National Institutes of Health funded trial of estrogen called ELITE (Early vs. Late Intervention Trial of Estradiol) to see how effective it is in slowing the hardening of arteries, the earliest stage of heart disease, in healthy post-menopausal women. He is hoping to determine whether the benefit depends on how soon after menopause women begin taking the hormones.

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http://www.usc.edu

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