Over the past several years, hormone replacement therapy (HRT) for women has all but died out. Extremely popular for years, HRT was stopped in its tracks after major clinical trials (most prominently the Women's Health Initiative study, and the Heart Estrogen/Progestin Replacement Study) were published showing that, not only did HRT fail to delay cardiovascular disease, but it also led to an increased risk of cardiac events. The consensus of expert opinion rapidly changed from "All women should get HRT," to "No women should get HRT."
Now, however, a new analysis of available data on HRT has been conducted, and with startling results. As published in the July issue of the Journal of General Medicine, investigators from Stanford University say that when HRT is used in younger women (those under 60 years of age,) the result may actually be a reduction in mortality.
In reaching this conclusion, the investigators conducted a meta-analysis, pooling data from over 26,000 women enrolled in in 30 randomized that compared HRT to placebo. They found that, overall, there was no difference in mortality between HRT and placebo. However, for patients under the age of 60 when HRT was started, there was a 40% reduction in mortality with HRT. This finding, obviously, flies in the face of current thinking regarding HRT.
What does this mean?
It has been said by statisticians far smarter than I that analysis is to meta-analysis as physics is to metaphysics. In this instance, in the 30 randomized trials subjected to meta-analysis, some enrolled women with heart disease, others enrolled women without heart disease; they used different combinations of hormone therapy; and therapies were applied for varying durations. Obviously, it is cannot be entirely clear what it means when the results of such disparate studies are combined and meta-analyzed.
At the least, however, this new meta-analysis calls into question the generally accepted notion that "no women should get HRT." Already one new study has been begun to specifically examine the question of whether younger menopausal women might benefit from HRT, and it is likely that other studies will also be initiated. For now, menopausal women under 60 who are interested in HRT should talk to their doctors about it, but should realize that, given the current state of the art, even after carefully considering all the evidence the best they can hope for is a well-educated guess.
