The editorial is a response to a study in the same issue of the journal that found that estrogen-only therapy, currently used in women with menopausal symptoms who have had a hysterectomy, may decrease breast cancer risk if it is used for fewer than five years. The study found this benefit persisted even after the hormone therapy was discontinued.
But in the editorial, Graham Colditz, MD, PhD, the Niess-Gain Professor of Surgery, and Emily Jungheim, MD, of Washington University School of Medicine in St. Louis, say that while short-term use of estrogen-only therapy appears safe, the long-term consequences of that short use are unknown.
The study, by researchers at Fred Hutchinson Cancer Research Center, looked at data from the Women's Health Initiative, a large study of the risks and benefits of hormone therapy in preventing chronic disease.
The researchers found that the negative effects of hormone therapy (HT), primarily stroke, went away after the women stopped treatment. Likewise, the benefits, mainly a decreased risk of bone fracture, also disappeared. The exception, according to the authors, was that a possible decreased risk of breast cancer found in the estrogen-only group continued even after therapy ended.
But Colditz and Jungheim caution doctors to look at the larger body of evidence that contradicts this finding and shows that hormone therapy may raise the risk of breast cancer. While estrogen therapy is commonly used on a short-term basis to manage menopausal symptoms after hysterectomy, Colditz and Jungheim say questions remain about its safety, including whether there is a safe duration of use.
The Women's Health Initiative (WHI) began recruiting participants in 1993 to look at the risks and benefits of hormone therapy (HT), including estrogen-only therapy, when used to prevent chronic disease.
At that time, not only was hormone therapy standard practice in treating women with menopausal symptoms, it was thought to be beneficial for preventing age-related diseases including heart disease, bone fractures and breast and colorectal cancers.
"Back then hormone therapy was prescribed almost like a vitamin," says Jungheim, assistant professor of obstetrics and gynecology.
That practice changed drastically as the WHI study was halted early because of an increased risk of stroke and no clear benefits in other disease categories.
In their editorial, Colditz and Jungheim question whether the WHI was an appropriate population to study when asking whether estrogen-only therapy is safe for treating the symptoms of menopause, including hot flashes, mood swings and sleep disturbances.
Generally, the women in the WHI do not represent the typical woman who might be prescribed hormone therapy for menopausal symptoms today. For example, 68 percent of the women in the WHI were over age 60 when enrolled in the study, making them older than the average woman entering menopause.
And though the women were followed for 10 years after therapy stopped, the average amount of time they actively took hormones was only three and a half years. Therefore, the WHI results cannot address the risks and benefits of longer-term estrogen use, they say.
Despite the risks, Jungheim still sees a role for short-term hormone therapy in treating women with severe menopausal symptoms, especially those experiencing premature menopause.
"The symptoms women experience around the time of menopause can be significant. There may be a role for hormone therapy for some women who cannot find relief from other things," she says. "But it's worth exploring other options including medications and lifestyle changes."
Jungheim suggests women discuss their symptoms with their doctors. Together, they can review the risks and benefits of the available treatment options and arrive at a personal strategy for managing their symptoms.
Jungheim ES, Colditz GA. Short-term use of unopposed estrogen: a balance of inferred risks and benefits. Journal of the American Medical Association. Vol. 305, No. 13. April 6, 2011.
LaCroix AZ, et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. Journal of the American Medical Association. Vol. 305, No. 13. April 6, 2011.
Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Julia Evangelou Strait | EurekAlert!
Investigators may unlock mystery of how staph cells dodge the body's immune system
22.09.2017 | Cedars-Sinai Medical Center
Monitoring the heart's mitochondria to predict cardiac arrest?
21.09.2017 | Boston Children's Hospital
Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.
A warming planet
Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.
The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...
Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...
Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!
When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...
For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.
Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...
19.09.2017 | Event News
12.09.2017 | Event News
06.09.2017 | Event News
22.09.2017 | Life Sciences
22.09.2017 | Medical Engineering
22.09.2017 | Physics and Astronomy