Younger Women May Benefit From HRT

It has been two years since the widely publicized Women's Health Initiative showed that the popular menopausal hormone therapy increased the risk of heart attacks and breast cancer. The study, however, was limited to older women who were years past the menopause. Now a review of smaller studies concludes that the benefits of HRT probably outweigh the risks for many younger women.

After combining the data from 30 trials comparing hormone use to nonuse, the researchers found a survival advantage for women who begin HRT before the age of 60. In women younger than 60, HRT reduced the risk of dying from any cause by 39% compared with women who did not take HRT at all. A survival advantage was not seen in studies on older women regardless of whether the women took HRT.

These data indicate that a large distinction needs to be made between the risks for women who start hormone therapy around the time of menopause and those who wait until they are older. Millions of women abandoned hormone therapy after the WHI findings were published in July of 2002, but most physicians still recommend its use in women who have hot flashes and other menopausal symptoms. The risks vs. benefits of treating younger women with hormone therapy, however, remain controversial.

Trials involving almost 27,000 women followed for an average of 4.5 years were analyzed. Most of the studies were conducted between 1990 and 2002, and all compared various outcomes among hormone users and nonusers.

The doctors concluded that hormone replacement was linked to a lower death rate among women beginning menopausal hormone treatment before the age of 60, but this was not true of women beginning menopausal hormone treatment later in life. Regardless of age, treatment did not appear to influence the risk of dying from cardiovascular disease or cancer. The reduction in death rates among younger women taking HRT was attributed to other causes and not to a reduced incidence of heart disease or cancer.