CHICAGO, May 27, 2003
Women
who take hormones for years run a higher risk of Alzheimer’s
or other types of dementia, according to yet another startling
study that turns upside down what doctors have long believed
about supplements.
“It's
another nail in the coffin” for
the use of hormones during and after menopause, said St.
Louis
gynecologist
Dr. Robert Blaskiewicz, a Saint Louis University professor.
The study appears on May 28, 2003 in Journal
of the American Medical Association.
The findings in women 65 and older challenge
the long-held notion that estrogen-progestin supplements
can help women keep their minds sharp — a belief
that was based on smaller, less rigorous studies.
Last summer, a government study was abruptly
halted after finding an increased risk of breast cancer,
heart attacks and strokes in women who took one type of combined
hormone pill.
That
finding shattered the conventional thinking about the
health benefits of hormones and
prompted millions of American women to stop taking supplements.
Some experts say that based on what is
now known about supplements, women past menopause
should not take hormones at all. Other experts say that women needing
relief from night sweats and other menopausal symptoms
should take the lowest possible dose for the shortest time.
The new findings on dementia come from
a subset of participants in last summer’s
study. Despite those earlier findings, many women
have continued
using supplements
to relieve menopausal symptoms and in hopes of
preventing memory loss and other mental decline,
said Sally
Shumaker, a public
health professor at Wake Forest University who
led the latest research.
Women in the study who took hormones for
an average of more than four years faced double the risk of
developing Alzheimer’s or other forms of
dementia, compared with those on dummy pills. That
means that
in one year, for
every 10,000 women taking hormones, there will
be 23 more cases of dementia.
Researchers also found that hormones did
not protect against less severe mental decline,
such as mild memory loss.
One possible explanation for the confounding
new findings is that hormones raise the risk of strokes — and
strokes are known to cause brain damage and contribute
to dementia, the researchers said.
Nevertheless, the increased risk of dementia
is very small, said Marilyn Albert, head of the Alzheimer’s
Association’s scientific advisory council
and a Johns Hopkins University neurology professor.
Age remains the single greatest risk factor for dementia,
and the study suggests that a 65-year woman on estrogen-progestin
pills “would
have the increased risk profile of a 70-year-old woman not taking hormone replacement
therapy,” Albert said.
Dr. Judith Salerno, deputy director of the National
Institute on Aging, said the results indicate older postmenopausal
women should not use
estrogen-progestin supplements in hopes of keeping their minds sharp.
“There is no benefit, and possible harm, for older
women taking this therapy,” she said.
Cindy Yeast, a 50-year-old Washington-area publicist, called
the findings disappointing. She started taking supplements two years ago — partly
to stave off mild dementia that affects her elderly parents. Still,
she said she is not sure the new findings will change her mind.
“Every time a new study comes out, you can’t
just react,” Yeast said. “You have to weigh what is this
doing for me now.”
The results come from the Women’s Health Initiative
Memory Study, which involved 4,532 women who used Prempro estrogen-progestin
pills for an average of more than four years. It was funded in part
by Prempro maker Wyeth Pharmaceuticals.
Probable dementia was diagnosed in 61 women — 40
in the hormone group and 21 taking placebo pills.
The notion that hormone supplements are good for the
mind has been around for at least a decade. Doctors have speculated
that estrogen protects against cell damage and improves blood flow.
Wyeth estimates that 1.2 million women are still taking
Prempro pills, down from about 3.4 million before the study was halted
last summer. Wyeth’s stocks price tumbled last summer when the first results
of the study were released.
Other types of hormone supplements include patches
and creams.
Wyeth’s Dr. Victoria Kusiak said it is unclear whether
the disappointing results would apply to younger patients. Still, she said she
agrees with those doctors who say that hormones should be used only to treat
menopause symptoms such as night sweats and hot flashes “for
the shortest duration and the lowest dose.”
An arm of the Women’s Health Initiative study
involving estrogen-only supplements in women who have had a hysterectomy
is continuing. Estrogen alone is not recommended for women with
intact
wombs because it increases the risk of uterine cancer.
© 2003
Associated Press.
Further
information
For millions
of women, the question of whether to take hormone replacement
therapy after menopause just got more confusing. All the
answers aren't in yet, but new findings suggest many of
the 6 million American women who use estrogen and progestin
should quit.
* If
you're using the hormone combination in hopes it will
protect your heart -- quit. Contrary to once-popular
belief, the pills can actually harm the hearts of previously
healthy women, the study found.
* If
you're using HRT to prevent osteoporosis, at some point
you should consider taking some of the other medications
which have not been shown to increase the risk for
breast cancer, such as raloxifene.
* If
a woman has severe hot flashes and finds relief with
HRT but now wants to stop, she ought to wean herself
slowly over time -- it may take up to six months. But
if one stops the supplements abruptly, the hot flashes
may come back severely.
* These
warnings don't apply to the 8 million more American
women who use estrogen alone - a therapy restricted
to those who've had hysterectomies because estrogen
causes uterine cancer unless balanced by progestin.
The NIH is letting a second, smaller study of those
women continue for now, saying the risks and benefits
remain unclear.
* The
National Institutes of Health urges women taking hormones
to talk with their doctors about what to do.
Menopause