The Other Side of the Hormone Controversy

Most experts say women should take hormones for only a few years after menopause, and only if their symptoms are severe. Now, in anew book, biologist Winnifred Cutler claims that HT is safe for long-term use and highly beneficial — as long as you do

By Stephanie Young
Photograph: Photo by: iStockphoto

A New Argument for Hormones
Could doctors have been wrong about hormones — again? In 2002, the authors of a large-scale study, the Women’s Health Initiative, set off panicky newspaper headlines by proclaiming that the risks incurred by women taking hormones outweighed the potential benefits. Many women and their doctors concluded that it was best to discontinue hormone therapy or use it only in the short term if menopausal symptoms were unbearable.
But that conclusion was wrong, insists biologist Winnifred Cutler, PhD. Like the study’s many other critics, she points out that the average age at enrollment in the WHI was 63; the study undersampled the younger women (ages 50 to 54), who, later analyses showed, may actually experience a lower risk of heart disease while on hormone therapy. Cutler also notes that the women in the study who still had their uteruses (some had undergone hysterectomy) given only one drug, Prempro, which combines conjugated equine estrogen (supplied by pregnant horses) and progestin (synthetic progesterone); other drugs, composed of different ingredients, may not present such risks.
In addition to her examination of the WHI, Cutler spent five years analyzing data from many other U.S. and international studies to parse out what’s really going on with HT. The controversial result, Hormones and Your Health: The Smart Woman’s Guide to Hormonal and Alternative Therapies for Menopause, out next month, argues that hormone therapy is not only good for you, it helps turn back the aging clock. Not every expert in her field agrees, but here she presents her reasoning.
Q. Tell us why you think hormones are so great.
A. Some are not! But combined with a healthy lifestyle, appropriately prescribed HT regimens can lengthen the span of your life, enhance your sexuality, build better bones, improve your posture, preserve your memory, help you sleep more soundly, sharpen your thinking and ability to learn, even out your moods, lower your odds of developing urinary tract infections, reduce your risk of colorectal cancer, and promote a healthier cardiovascular system.
Let’s consider heart health. Among the 120,000 women followed for 20 years in the Nurses’ Health Study, hormone users were 40 percent less likely to develop heart disease or to die. Or look at diabetes. A 2003 report from the HERS trial, conducted at 20 U.S. clinical centers, found that hormone users had a significantly lower risk of developing type 2 diabetes. What’s more, hormones can make you look younger. Estradiol or estriol [variants of human estrogen] in a face cream significantly reduced crow’s feet in six months in a University of Vienna study and similar research conducted at Yale University School of Medicine.
With demonstrated benefits like these, why take HT for only a few years after menopause? That advice does not withstand my scrutiny.
Q. One argument for limiting hormone therapy to short-term use is that it has been shown to increase the risk of breast cancer, right?
A. It is dangerously wrong to throw all hormone regimens into the same category when discussing breast cancer. For instance, the multicenter Women’s Contraceptive and Reproductive Experience study, which started in 2002, examined breast cancer risk in relation to specific hormone regimens, and reported that taking continuous-combined HT — the Prempro type — for five or more years was the only routine that increased the risk of developing breast cancer. The danger increased the longer women used that form of drug. No other hormone regimen showed increased risk.
In addition, some European studies support the safety of hormones that are chemically identical to human estradiol and progesterone in regimens where estradiol is taken every day and progesterone is added during the last half of the month.

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