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!
Second cause of hidden hearing loss identified
20.02.2017 | Michigan Medicine - University of Michigan
Prospect for more effective treatment of nerve pain
20.02.2017 | Universität Zürich
Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...
The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.
The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...
Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...
Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".
Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...
13.02.2017 | Event News
10.02.2017 | Event News
09.02.2017 | Event News
21.02.2017 | Earth Sciences
21.02.2017 | Medical Engineering
21.02.2017 | Trade Fair News