I have on-going discussions with patients who have been on hormone therapy for more than five years as to whether they should continue or stop. There is a valid concern about a potential increase in risk of breast cancer with long term estrogen and progestin therapy. (The use of estrogen only in women who have had a hysterectomy does not seem to have the same breast impact.) Patients then question whether they “need” hormones anymore. And finally, what does hormone therapy do for coronary vascular health? (Remember, the major cause of mortality for women is heart attack.) The latter question was partially answered by an article published in the “Journal of Endocrinology and Metabolism” which was also reported during a session at the North Menopause Society annual meeting. No I don’t read that journal (although I am sure it is terrific reading for endocrinologists…) and I wasn’t at the annual meeting of NAMS. I discovered it on the American Congress of Obstetrics and Gynecology website. (I hope all these names of organizations and journals will, at least, be somewhat impressive!)
The lead author is from Helsinki University Hospital in Finland. He and his colleagues identified 332,202 women who discontinued hormone therapy from 1992 to 2009. In the first year after hormone discontinuation, the risk for cardiac death and stroke was significantly higher (by a factor of two) in the discontinuers than in the women who continued their hormone therapy. However, beyond one year their risk was slightly lower. The mean exposure to hormone therapy in these women was 6.2 years and the mean follow up after discontinuation was 5.5 years… so the data is pretty convincing. But I should add, the study was partially supported by pharmaceutical companies.
The author’s summation was that in women 50 to 60 years of age who are on hormone therapy and stop “we clearly see that this is doing more harm than benefit. If women are otherwise healthy they could continue hormone therapy as long as they wish.”
This is one more observational study that helps me discuss the positive benefits of hormone therapy and perhaps will reassure those who wish to continue. But as always each patient’s risk factors and symptoms should be discussed…