New York Times
The news keeps getting worse about the value of hormone replacement therapies for postmenopausal women. Less than three months ago an international panel concluded that there was little evidence to support many of the presumed benefits of the treatments. Now federal health officials have halted a large study of hormone replacement therapy because the regimen used, a combination of estrogen and progestin, was doing more harm than good when taken for several years. The action has been met with shock and disbelief by many women and their doctors.
The danger to any individual woman appears very slight. But this discouraging saga offers a sobering lesson in how aggressive marketing by the drug industry and a fervent desire for medical miracles on the part of patients and doctors can propel use of a drug far beyond that justified by scientific data. ...
One bright spot at this time when desperate drug companies are hyping their products beyond reason -- and when the corporate and financial worlds seem enmeshed in shady dealings -- was the impeccable integrity of this well-designed scientific study. The findings could not have been pleasing to Wyeth, the manufacturer of the drug combination being tested, whose shares plunged sharply on the news. But the National Institutes of Health and the researchers themselves had no qualms about terminating the study and announcing the results for the benefit of patients and their doctors. If only the business world could be so forthcoming.
The bombshell announcement that long-term hormone replacement therapy causes heart problems has thrown millions of postmenopausal women into turmoil. Doctors say there's no need to panic, but they are advising many women to stop taking the pills that have kept them feeling better for years, even decades.
It had long been suspected that hormones increased the risk of breast cancer, which scared some women off. But millions more chose HRT despite that risk. It was also known that HRT did not prevent women with heart disease from getting repeat heart attacks. Nevertheless, until this week many clung to the hope that HRT might still prevent heart disease in healthy women. That hope has now been dashed.
The most definitive trial ever undertaken in this area has found that the combination of estrogen and progesterone reduces the risk of bone fractures and colorectal cancer. But it increases the risk of heart attacks, strokes and blood clots, in addition to the risk of breast cancer. The increased risks are small but significant.
Every woman needs to weigh her risks and benefits in light of what is known, factoring in her own preferences. That calculus is now far more complicated.
In analyzing the pros and cons, women should not lose sight of the primary indications for which HRT was approved: alleviating hot flashes and treating vaginal dryness. Many women are plagued by these symptoms as the shutdown of their ovaries at menopause causes their natural hormone levels to plummet.
The conclusion of the study leaders was that women should not take combined HRT for disease prevention. No one said they should not take it for the time-limited treatment of symptoms that are compromising their quality of life. ...
Much remains unknown: Why does combination HRT increase the risk of certain diseases? Perhaps the culprit is the progesterone. Perhaps different types of hormones would be less risky.
We also don't know much about the safety of taking HRT for a year or two or three--probably long enough to help most women through the worst of their symptoms. To answer these questions we need more well-designed clinical trials. Women need and deserve to know.
Los Angeles Times
Feminine forever. That was the sizzle that first sold millions of menopausal women on estrogen pills in the 1960s. This fountain of youth in a bottle would keep women from becoming "dull and unattractive," according to one of its early pitchmen, and make them "much more pleasant to live with."
Who could resist? What woman would choose to shrivel and sag when she could remain dewy and pert by popping a pill? Who wouldn't rather avoid the drenching night sweats, embarrassing hot flashes and mood swings? ...
But Tuesday, scientists abruptly ended a large national study on hormone replacement therapy after concluding that the regimen did more harm than good. The government-funded trial, which tracked 16,608 women taking either estrogen and progestin or a placebo, was halted after it became clear that the drugs caused a slight but significant increase in the risk of breast cancer, heart attacks, blood clots and strokes.
Six million American women who until this week had been taking the drugs now have new fears.
The silver lining to this week's news, if there is one, is that women's medical issues, too long ignored, now finally command the attention of researchers. Also more visible is an emerging acceptance of menopause and aging.
Like other health issues once discussed only in embarrassed whispers, menopause has in recent years become the subject of comedy sketches and talk show confessionals, generating a cottage industry of support groups and products. As of Tuesday, it was also dinner- table conversation.
The new developments underscore what most women knew all along: that aging is inevitable, that there is no magic pill to stop the clock. Vigorous middle and later years--what Anne Morrow Lindbergh called "the flowering that waits for afternoon"--are likely to rest on the basics: a healthful diet, regular exercise and a life of meaning.
Now there's a hot flash.
San Jose Mercury News
Since the 1960s, when estrogen pills were touted as the way for middle-aged women to remain ``feminine forever'', menopause has been portrayed as a disease to be treated instead of a natural phase of life.
In a society increasingly fixated on youth, in which women in their 50s can look forward to decades of health and vitality, hormones have enabled millions of women to skip the debilitating symptoms of menopause and prevent some of the curses of old age, from osteoporosis to wrinkles. Yes, there were risks, but they appeared to be outweighed by the benefits.
Until this week. A government study suddenly was halted when it showed that the popularly prescribed combination of estrogen and progestin, taken over several years, increased risk of breast cancer, heart attacks, strokes and blood clots.
The news prompted a flood of calls to doctors' offices from worried patients and a 24-percent drop in the stock price of the drug company Wyeth, which sold more than $2 billion in hormones last year.
These results from the Women's Health Initiative are significant because they represent the first major, long-term, randomized, government-supported study of drugs that have been heavily marketed to women for more than three decades. The study came about because researchers such as Dr. Marcia Stefanick of Stanford University challenged the accepted wisdom that hormone therapy was a cure-all for aging.
This study won't -- and shouldn't -- discourage all hormone therapy. While the research halted this week focused on the long-term value of hormones in preventing disease, other aspects of the study will continue. There is still much to be learned about the health of older women. ...
There are alternatives to hormones. Perhaps this study will create an incentive to develop still more. If there is a lesson in the ``feminine forever'' myth, perhaps it is that women and their doctors should focus on alleviating the individual symptoms that come with aging rather than count on a magic way to stop the clock.
A scientifically rigorous study that raises questions about the risks of a hormone-replacement regimen grew from complaints that women's health issues received scant federal attention.
The protests on Capitol Hill paid dramatic dividends.
The study was halted early when researchers found a combination of estrogen and progestin caused small increases in breast cancer, heart attacks, strokes and blood clots.
Hormone-replacement therapy has been long used to relieve menopause symptoms. Over time, the argument was made the drugs should be taken by post-menopausal women because the benefits could include disease prevention, such as osteoporosis.
Strong evidence existed the drugs were good for prevention of heart disease, so broad assumptions were made without scientific inquiry. ...
We live in a time when many consumers fancy themselves medically literate. Patients have enormous influence in the choice of treatments and medicines they receive, or so a lot of expensive advertising for prescription drugs suggests.
Questions remain about hormone replacement, but the new findings are a triumph of science over assumptions and marketing.
(Compiled by United Press International)