Hormone therapy risky when started after menopause
Last Updated: 2007-07-11 16:00:40 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Findings from a new study confirm previous reports that starting hormone replacement therapy (HRT) many years after menopause increases the risk of heart and vascular events and blood clots.
In 2002, findings from the Women's Health Initiative (WHI) trial were published, which showed elevated risks of heart attack and stroke in postmenopausal HRT users compared with nonusers. The current results stem from the Women's International Study of Lung Duration Oestrogen after Menopause (WISDOM) trial, which was initiated in 1999, but stopped early after the WHI results appeared.
As reported in the July 11th Online First issue of the British Medical Journal, Dr. Alastair H. MacLennan and the rest of the WISDOM team assessed the outcomes of 5,692 women, between 50 and 69 years of age, who were randomized to receive estrogen-only HRT, estrogen plus progesterone HRT, or placebo. The average period from menopause to HRT initiation was 15 years.
Although 10 years of treatment was planned, the study was stopped early after a median follow-up period of 11.9 months, MacLennan, from the University of Adelaide in Australia, and colleagues note.
Compared with placebo, use of combination HRT was associated with significantly increased risks of major cardiovascular events (7 vs. 0 events) and blood clots (22 vs. 3).
No significant differences in outcomes were noted between combination and estrogen-only HRT.
By contrast, HRT use did not affect the risks of cancer, cerebrovascular events like stroke, fractures, or death, the report indicates.
"Research is needed to assess the long term risks and benefits of starting HRT near the menopause, when the effect may be different," the authors note.
In a related editorial, Dr. Helen Roberts, from the University of Auckland in New Zealand, recommends use of vaginal estrogen products for bothersome genital and urinary symptoms following menopause.
These symptoms "usually last a long time and require ongoing treatment." Recent position statements support long term use of low dose vaginal estrogen preparations as long as distressing symptoms remain, Roberts noted.
SOURCE: BMJ Online First July 11, 2007.
