Risks of Hormone Therapy
Written by Faith Anderson on May 29, 2012
Clinical Trials Expose Risks of Hormone Therapy
Years ago, hormone therapy was thought to offer women protection against cardiovascular problems, dementia and osteoporosis, so doctors routinely prescribed the therapy to otherwise healthy women to prevent these conditions. This practice was halted about ten years ago when the Women’s Health Initiative trial, which was designed to confirm these hypotheses, was terminated early. According to the trial, women using hormone therapy for this purpose were actually at higher risk for many of the issues that the treatment was supposed to prevent. “In the face of pretty good evidence, the balance of potential benefits and potential harms leads us not to recommend the use of these therapies,” said Dr. Kirsten Bibbins-Domingo, a member of the task force.
The new recommendations presented by the task force are based on a review of data, published Monday in the Annals of Internal Medicine, which covers nine clinical trials over the last ten years. While the standard of care shifted for many physicians after the Women’s Health Initiative trial was halted, updated recommendations from the task force are important because many patients still have questions and many physicians are reluctant to let go of old prescribing habits, said Dr. Carolyn Crandall, a professor of medicine at the David Geffen School of Medicine at UCLA. “It’s not that the findings are new,” said Crandall. “But they give a practical sense about how to counsel someone about the rare but serious harms of taking hormone therapy.”
Side Effects Vary Depending on Age and Risk Factors for Disease
When weighing the risks and benefits of hormone therapy, there are certain factors that must be taken into consideration, including youth and a person’s specific risk factors for disease. As Crandall says, “The balance of benefits or harms may be different with young women, so you can’t say this absolutely applies to younger women making hormone therapy decisions.” In light of the possible risks though, which are well-known among professional organizations, many doctors have greatly limited how they apply the treatment. The American Congress of Obstetrics and Gynecologists warns against hormone therapy for preventing cardiovascular disease on its website. The North American Menopause Society stresses the same cardiovascular risks and advises that a woman’s personal risk factors should play a role in determining whether hormone therapy is safe for them.
The panel acknowledges research gaps when it comes to hormone therapy for chronic illness, specifically as it affects younger women. The average age of women involved in the Women’s Health Initiative trial was 64 years, well past the age that menopause usually begins. Crandall comments that the task force recommendations “are aimed at older women, who are generally healthy asking, ‘If I take a pill a day, will I prevent a heart attack?'” As Dr. Joseph Sanfilippo, vice chairman of reproductive sciences at Magee-Women’s Hospital in Pittsburgh, says, “The bottom line is clinicians must take all clinical parameters into account for the patient and prescribe the lowest dose for the shortest duration of time.”