Value of long-term hormone replacement therapy questioned

Short-term benefits are clear, but physicians and patients are faced with an ever-increasing collection of conflicting reports about advantages over the long run.

By Victoria Stagg Elliott, AMNews staff. March 4, 2002.

Last month, a study in the Journal of the American Medical Association found that the incidence of breast cancer increased by as much as 85% among women who used hormone replacement therapy over the long term. Another study in JAMA just the week before found that quality of life, long a deciding factor in whether to initiate therapy, did not improve.

These studies are the latest in a barrage of papers looking into the risks and benefits of HRT.

"It's impossible to keep up," said Ann Zerr, MD, medical director of the Indiana University National Center of Excellence for Women's Health in Indianapolis. "This is a very frustrating area for physicians right now."

HRT has been implicated in increasing the risk of ovarian cancer, blood clots, gallbladder disease and dry eye syndrome. It may worsen asthma and may increase insulin resistance.

Or maybe not. Or maybe other benefits outweigh the risks.

It may improve heart health, although the American Heart Assn. issued a scientific statement last year saying there was not enough evidence to recommend it for primary prevention. For those who already have some heart disease, it may make the situation worse. It may prevent Alzheimer's disease and macular degeneration, and it definitely staves off osteoporosis.

"There must be some good things about hormone replacement therapy," Dr. Zerr said. "But I'm not sure what they are right now."

For doctors, short-term use of the decades-old therapy is considered a no-brainer with clear-cut benefits, but the advantages of its use for more than the hot flashes and night sweats associated with the onset of menopause are a question mark. [...]