Estrogen Exposed, Doctors in Denial

by Amy Allina

NWHN is calling for doctors to help their patients understand the science behind the March decision by the National Institutes of Health (NIH) to halt the estrogen-only arm of the Women's Health Initiative (WHI). Over the trials nearly seven year duration, women taking estrogen alone were found to experience an increased risk of stroke and a trend toward increased dementia, although no effect on their likelihood of developing heart disease or breast cancer, and a decreased risk of bone fracture. There were fewer risks for women taking estrogen than tor women taking combined hormone therapy but the higher stroke rate was based on the experiences of women who had been in the study for only two years. Details of the study were published in April and June.

The NIH announcement confirms that while short-term use of hormone therapy may offer relief from hot flashes and night sweats, it is not without risk. Women who are trying to decide whether to take hormones for short-term relief of these symptoms must be informed about the risks of relying on that treatment, even if they have had a hysterectomy and can take estrogen therapy alone. The increased risk of dementia and cognitive decline is also important for women who are weighing the decision to continue medical treatment of hot flashes as they get older.

When the results of the estrogenonly arm were released this past March, NWHN pointed out that defenders of hormone therapy have spent the two years since NIH halted the first arm of the WHI trying to poke holes in the trial results. Those results, of course, showed that combined hormone therapy increased women's risk for heart disease, stroke, breast cancer and dementia. Defenders of hormone therapy also argued that estrogen alone might offer benefits that combined hormone therapy did not. The results published in April and June are further evidence that it's time for opinion leaders in the medical community to accept the bottom - line conclusion that long-term use of hormone therapy and estrogen therapyposes serious risks to women and does not offer unique benefits.

NWHN has called on doctors to stop efforts to undermine confidence in the findings of the WHI and start advising women based on the evidence. In her statement, NWHN Executive Director Cindy Pearson explained, "Women have been hurt by the medical community's reluctance to accept that theories which it has held for decades about the purported benefits of taking hormones were wrong. Instead of putting their creative energy into inventing reasons to disbelieve the WHI evidence, doctors should be coming up with ways to help women do the things we know will, in fact, help us stay healthy as we age."

Though medical practice may be slow to change, some women have been voting with their feet. After the earlier WHI results were released, more than a third of women with prescriptions for combined hormone therapy stopped using the therapy, according to Express Scripts, a U.S. pharmacy service. However, the majority of women using hormones (57 percent) stuck with them. A study conducted at Kaiser Permanente in Northern California found that the strongest predictor of whether a woman tried to stop taking hormones after the WHI was whether she had received information from her physician explaining the study results. Pearson said this shows that "Women can make good decisions in the interests of their own health if we provide them with good information. The WHI results give us the data we need. The question is whether doctors will share that with their patients or continue to give advice based on old, disproven beliefs and biases."

The results of the estrogen-only arm of the WHI were published in The Journal of the American Medical Association, Vol. 291, No. 14, pp. 1701 1712, April 14, 2004 and Vol. 291, No. 24, pp. 2947-2968, June 23/30, 2004. &