The longest, most
comprehensive follow-up yet of women given hormone pills during landmark
government research found many health risks faded and some unexpected benefits
emerged, but advice remains unchanged: Use hormones only short term if needed
to relieve hot flashes and other menopause symptoms.
In the follow-up involving
more than 27 000 women, researchers analysed 13 years of data, including up to
eight years of information on what happened after women stopped taking
replacement hormones – oestrogen alone or with progestin. The researchers
present the most detailed information yet on hormones' health effects by age,
and include new information on risks based on time since menopause.
Oestrogen pills, used by
women who've had a hysterectomy, appeared to be safer, especially for younger
women – those who started taking hormones in their 50s, the study found. That's
mainly because of a persistent breast cancer risk among women who'd taken the
combined oestrogen-progestin pills. Also, heart attacks risks were strongest
among women given combined pills when they were in their 70s and decades past
menopause – although in the real world, most hormone users start taking them at
younger ages, when risks are lower.
Risks outweigh benefits
For both types of pills,
"risks will still outweigh benefits for women who are at older ages,"
even if they have persistent hot flashes and other menopause symptoms , said
lead author Dr JoAnn Manson, preventive medicine chief at Harvard's Brigham and
For women in early
menopause, the quality of life benefits likely outweigh the risks, she said.
Hormones were once thought
to help prevent a variety of age-related ills and many women considered them a
staple for retaining their youth. The research was launched in the 1990s to
examine some of those beliefs, and the new results confirm that hormones should
not be used for disease prevention.
Participants took oestrogen-only
pills for about seven years, oestrogen-progestin pills for about five years or
dummy pills. The government stopped both studies, in 2002 and 2004, after more
health problems were found among hormone users than those assigned to take
The new study includes
follow-up through 2010, and some results confirm findings seen earlier. The
study appears in the Journal of the American Medical Association.
"It's helpful to have
the further analysis. It reaffirms what we've actually been practicing for a
while," said Dr Elizabeth Ross, a heart specialist at the MedStar Heart
Institute in Washington, DC.
But she noted that the
study didn't examine other forms of menopause hormones, including patches and
creams, and added, "I don't think the door is closed on our understanding
of hormone replacement."
Besides increased risks
for breast cancer, and heart attacks mostly among older women, results for oestrogen-progestin
- Risks for strokes and
blood clots found during treatment faded but did not completely disappear.
- Hormone users had fewer cases
of uterine cancer, a benefit not seen during the treatment phase.
- Fewer hip fractures
occurred among hormone users, though this benefit was less robust than during
Results for oestrogen-only
users, compared to dummy pills:
- Fewer breast cancers were
found, a result also seen in an earlier follow-up.
- No increased heart attack
risks were seen, even among the oldest women.
- Risks for strokes and
blood clots disappeared after stopping the pills.
- A reduction in hip
fractures seen in the treatment phase faded.