There was some crap science reported in 2002 that encouraged older women to give up their Hormone Replacement Therapy. The science was crap because the differences between groups that it relied on were not apparently statistically significant. See my post of October 27 2003. There is also a dismissive academic re-analysis of the 2002 “findings” here.
Nonetheless, everybody hates drug companies so doctors everywhere jumped on the bandwagon and tried to get women off their pills. We now see how dangerous crap science is. It looks like the advice could have killed a lot of women. Read this report:
“Hormone replacement therapy significantly increases the life expectancy of older women, but only if they begin taking the drugs soon after the onset of the menopause, a major review of the evidence has found. A new analysis of 30 trials involving a total of 26,708 women has revealed that the benefits of the treatment substantially outweigh the risks, so long as it is started before a woman reaches the age of 60. In women who started HRT at 56, the risk of death from all causes was cut by 39 per cent”.
Some more high quality data has just emerged which scotches the risk of increased heart attacks in women on HRT but which did find a slightly increased incidence of stroke. Abstract follows:
Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause
By Rossouw JE et al.
CONTEXT: The timing of initiation of hormone therapy may influence its effect on cardiovascular disease.
OBJECTIVE: To explore whether the effects of hormone therapy on risk of cardiovascular disease vary by age or years since menopause began.
DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of the Women’s Health Initiative (WHI) randomized controlled trials of hormone therapy in which 10,739 postmenopausal women who had undergone a hysterectomy were randomized to conjugated equine estrogens (CEE) or placebo and 16,608 postmenopausal women who had not had a hysterectomy were randomized to CEE plus medroxyprogesterone acetate (CEE + MPA) or placebo. Women aged 50 to 79 years were recruited to the study from 40 US clinical centers between September 1993 and October 1998.
MAIN OUTCOME MEASURES: Statistical test for trend of the effect of hormone therapy on coronary heart disease (CHD) and stroke across categories of age and years since menopause in the combined trials.
RESULTS: In the combined trials, there were 396 cases of CHD and 327 cases of stroke in the hormone therapy group vs 379 cases of CHD and 239 cases of stroke in the placebo group. For women with less than 10 years since menopause began, the hazard ratio (HR) for CHD was 0.76 (95% confidence interval [CI], 0.50-1.16); 10 to 19 years, 1.10 (95% CI, 0.84-1.45); and 20 or more years, 1.28 (95% CI, 1.03-1.58) (P for trend = .02). The estimated absolute excess risk for CHD for women within 10 years of menopause was -6 per 10,000 person-years; for women 10 to 19 years since menopause began, 4 per 10,000 person-years; and for women 20 or more years from menopause onset, 17 per 10,000 person-years. For the age group of 50 to 59 years, the HR for CHD was 0.93 (95% CI, 0.65-1.33) and the absolute excess risk was -2 per 10,000 person-years; 60 to 69 years, 0.98 (95% CI, 0.79-1.21) and -1 per 10,000 person-years; and 70 to 79 years, 1.26 (95% CI, 1.00-1.59) and 19 per 10,000 person-years (P for trend = .16). Hormone therapy increased the risk of stroke (HR, 1.32; 95% CI, 1.12-1.56). Risk did not vary significantly by age or time since menopause. There was a nonsignificant tendency for the effects of hormone therapy on total mortality to be more favorable in younger than older women (HR of 0.70 for 50-59 years; 1.05 for 60-69 years, and 1.14 for 70-79 years; P for trend = .06).
CONCLUSIONS: Women who initiated hormone therapy closer to menopause tended to have reduced CHD risk compared with the increase in CHD risk among women more distant from menopause, but this trend test did not meet our criterion for statistical significance. A similar nonsignificant trend was observed for total mortality but the risk of stroke was elevated regardless of years since menopause. These data should be considered in regard to the short-term treatment of menopausal symptoms.
Putting that into plain English: 2% of women on the pills had a stroke versus 1% who were not on anything. That’s a pretty tiny risk. And all drugs and therapies have side effects. The iron rule of drug therapy is: No side effects = no main effects either. So the slightly increased risk of stroke has to be weighed against the risk of brittle bones. Any woman with either a family history of osteoporosis or some osteoporosis already visible in herself via a bone-density scan would be pretty foolish not to go onto HRT in my non-medical opinion. By going onto HRT you would be taking a tiny risk in order to avert an almost certain major problem.
There are some more reactions to the recent study here.
NHS blog doctor has a coverage of the subject but I cannot see why he is so indecisive about what to recommend in the circumstances. Maybe he can’t follow the statistics. He would not be alone in that. I used to teach social statistics in a major Australian university and I find medical statistics pretty obfuscatory. They seem uniformly designed to make mountains out of molehills.
Many times in the academic literature I have excoriated my colleagues in psychology and sociology for going ga-ga over very weak correlations but what I find in the medical literature makes the findings in the social sciences look positively muscular. In fact, medical findings are almost never reported as correlations — because to do so would exhibit how laughably trivial they generally are.
The 2002 study was the basis for a great drama, with the risk of breast cancer particularly highlighted. The study was halted when too many women on HRT were getting cancer. The women on HRT in the study were told to throw away their pills because they were too risky. And millions of women worldwide followed suit.
But what they actually found was that 3 women in a thousand in their study group who were NOT taking HRT pills got breast cancer. So how many who WERE taking HRT got breast cancer? 4. Yes. 4. 4 out of a thousand compared to 3 out of a thousand. See here. Some people have just got no sense of proportion.
So, regardless of statistical significance (statistical significance simply tell you that the result was unlikely to be an effect of small sample size), there was absolutely no real-world significance in the result. It could have been due to any number of randomly-present factors. Aren’t we lucky to have such wise medical attention-seekers researchers to guide us?
(For more postings from me, see TONGUE-TIED, EDUCATION WATCH, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, SOCIALIZED MEDICINE, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here.)
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6 users commented in " HRT PANIC FINALLY LAID TO REST? "
Follow-up comment rss or Leave a Trackback“Crap” science?? How is a randomized double-blind placebo controlled trial “crap”? The new analysis of that trial is merely exploratory and was not part of the original protocol, so its results are inconclusive. This new data isn’t inherently more “high quality” than overall data reported in 2002. On that note, none of the findings in younger women were statistically significant, which means they could have occurred by chance. And, hypothetically, if a heart benefit that so many “experts” think exists from taking HRT at the start of menopause, there is no way to tell, whatsoever, if it would last. After all, estrogen couldn’t possibly be the only factor having to do with the aging and health of a woman’s arteries. In addition, I would love to know how a drug could possibly prevent the same disease it exacerbates once it exists. That is scientifically flimsy and counterintuitive. Trying to force the results (which seems to the be the thinly veiled motive behind this new analysis) does women no good. People are going to have to accept the fact that menopause does not “cause” heart disease and that HRT doesn’t prevent it. And a heightened risk of breast cancer and stroke (at ANY age) doesn’t sound too reassuring if you ask me. Lastly, observational data (like those cited above about reduced mortality among under-60 HRT users) do NOT count as proof; they are suggestive, nothing more. And to try and contort a clinical trial to match unreliable observational studies represents a real lack of objectivity.
I continue to read these comments about HRT which totally ignore BIO-IDENTICAL hormone replacement therapy. You all must be in some way representatives of the conventional medical establishment or are connected to the non bio-identical hormone pharma companies. How much common sense is required to understand that if you replace something in the body, in this case a chemical, you should replace it with a chemical as close as possible to the one that occurs in the body. That’s what bio-identical hormones are, identical chemicals to the hormones in the body. The Women’s Health Initiative used hormones that are made from horse urine and that have components in them that are alien to the body. And guess what, like all alien matter introduced into the body, the liver produces c-reactive proteins in response. C-reactive proteins cause inflammation. And guess what, inflammation is a major factor in producing most illness in the body, including heart disease and cancer. Why does this occur, again, common sense, constant inflammation causes breakdown of cell processes because of stress. The cells wear out, lose their intelligence. Unadulterated BIO-IDENTICAL HORMONES do not produce inflammation, and if prescribed in the proper manner, not only are safe, but are extremely beneficial for both women and men. A large portion of the population is aware of this, when are the rest of you going to get it? This is beyond ridiculous, this information has been around for decades. There is only one reason that bio-identical hormones weren’t studied in the WHI, cash! Big pharma, most notably Wyeth is now trying to stop the formulation of bio-identical hormones which are cheap and unpatentable by getting foolish congressman to shut down the compounding pharmacies. If you care about your health you will call Edward Kennedy, Pat Roberts and Richard Burr who are responsible for legislation supporting this absurd notion. These people listen to the ignorant conventional doctors who have never had an original thought and the drug companies who manipulate and finance them, and in the process, they jeopardize our health. Anyone can look at Sen Kennedy and see that he needs hormone replacement. He is overweight, and his back is stiff, two clear signs of hormone deficiency.
True, bioidenticals haven’t been studied! Which is why their safety isn’t proven. They sound “better” but you have to have a randomized clinical trial to PROVE they don’t have any risks and are in fact better for you than conventional hormones. By the way, the word “synthetic” applies to ALL hormone therapies. They are all “synthesized” in a lab. Last I heard, they hadn’t discovered a bioidentical HRT pill or patch growing from a bush. If what you mean is “artificial” then you would still be incorrect. Premarin is a mixture of natural estrogens (mostly estrone sulfate) from a rather vile source (horse urine). This is actually the predominate estrogen in postmenopausal women’s bodies. So in a nutshell, this idea that there is such a vast difference between so called bioidentical estrogens and “synthetics” has no data to back it up. No one’s saying they’re any better or worse for you; it’s just that scientists don’t know. Women are best served, FOR NOW, to assume Premarin’s risks apply to other hormone therapies until prospective trial data prove otherwise.
this study is on C.E.E and C.E.E+M.P.A and what about TIBOLONE, whether it s safe or not,
have u got any study?
HRT PANIC FINALLY LAID TO REST?
Do you work for a DRUG company?
I was off taken off HRT medication in August, 2002 after the STUDY came out in June, 2002 (apparently my doctor took the study seriously!)
That made me very happy until I found out I turned out to be one of the 28% (in all the JAMA articles I have read) to get CANCER from having taken HRT medication!
I was diagnosed with breast cancer in October 2002!
The two centimeter malignant tumor was not found by my gynecologist nor myself with an exam! It was found on a MAMMOGRAM. Determined by the Pathologist to be HORMONE FED!
I had taken the “wonder drugs for HRT”, of which, the drug companies made to sound like the greatest medicine in the world. False statements were made in their ads in all the major women’s magazines.
They made it sound like a NECESSARY drug and it was NOT! The drug worked fine for relieving symptoms of menopause, but the symptoms of menopause do not last long, perhaps a year.
I was told by my Doctor, when I asked how long I had to take them (CONDERNED ABOUT EXPENSE, NO PRESCRIPTION COVERAGE!) that I had to take them the rest of my life! Wrong! My thoughts NOW, are, you take them until they cause cancer and KILL you!
Talk about expense! I had untold out of pocket medical bills in addition to those that the insurance company paid after my diagnosis of breast cancer!
What happened with me later, after stopping the treatment, is, I suffered menopause symptoms all over again at the same time I was undergoing the cancer treatment, horrific!
Yes, I am now a STATISTIC in the cancer count.
If they do a new study or statistical count, you can bet I will try my best to be included.
You should not make light of the studies! More studies should have been done before the DRUGS were put on the MARKET.
Women have gone through MENOPAUSE in the past without HRT medication and were the more healthier as a result!
How do you explain the new study that cancer rates have dropped since the HRT is not being prescribed as much for women now?
I advise NO one to take HRT medication unless they want to experience worse health issues because of it. Everyone I meet I tell them about my experience and to consider the consequences for taking it or NOT and that they should get hold of a medication insert BEFORE having the prescription filled!
Let me tell you, you need to rethink the statements you made in this blog. Indeed calling the study CRAP!
It is real and true that HRT medicines can cause cancer. I am living PROOF! There is no history of breast cancer in my family.
I am into my fifth year of being cancer free. But one never knows if, and when, cancer can strike again, odds are I can get it in the other breast or ovaries perhaps, just from taking HRT medications! A thought I live with every day.
Cancer treatment is no picnic, and no one should suffer needlessly for a drug company’s profits! There are also more things I suffer from now, as a result of the cancer treatment, (too many to mention here).
I am glad you chose to write your blog because it gave me a chance to rebuke what you stated and helped me to vent and express my point of view from another perspective.
Now I will never put another substance into my body except FOOD!
NO MEDICATIONS AT ALL FOR ME, FOREVER, I HOPE!
Keeping one’s immune system in tiptop shape is the way to go.
Just saw JWR’s comments. No one mentioned the word “synthetic” that JWR has latched onto to prove how inept others are in their comments. Of course, unless someone took hormones from another human and injected them in another, then any hormones made for ingestion are synthetic. The key words are “bioidentical” and “non-bioidentical.” Please take the time to look at the molecular structure of the horse urine hormones, they have non-bioidentical aspects. These aspects are what make them PATENTABLE and therefore PROFITABLE. Bio-identical hormones are exactly like human hormones and can’t be patented. This is a major distinction when one is ingesting these “synthetics.” Oh, and the, as you state it, “rather vile source” (horse urine) is harvested at the expense of the horses who are kept imprisoned in stalls while pregnant to collect the urine. Why would anyone support such an unnecessary and abhorrent process when the hormones can be made from cheap plant sources that harm no one. Your callousness further undermines your position.
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