Susan Pierres, a Miami photojournalist who just turned 60, is confused and angry. Ten years ago, when she was approaching menopause, her doctor started her on hormone-replacement therapy, or HRT. "I didn't have any symptoms," she recalls, "but he recommended it for general well-being, bones and heart." Many years and pills later, her gynecologist suggested that perhaps it was time to stop. After all, there had been reports that HRT might increase a woman's risk of breast cancer, a disease that had afflicted Pierres' mother and aunt. She turned to several other physicians for advice. They couldn't seem to agree. Now comes word from a really big study that taking HRT for years at a stretch isn't such a great idea after all.
Should Pierres believe these latest results or go back to her doctor for an explanation? Which doctor? It's not as though she's all that eager to get off hormones: "You feel it is your last vestige of youth. What if my skin turns scaly and my hair falls out?" she worries. "These are complicated matters. People like me don't know where to go or whom to listen to."
Whom indeed. For decades, millions of women like Pierres have been told that HRT is a veritable fountain of youth. It kept the skin supple, held back heart disease, boosted old and brittle bones and might even have staved off senile dementia. More than 40% of all women in the U.S. start some form of HRT in their menopause years. Many of them continue well into their 70s and 80s, convinced that the little pills give them a youthful glow.
Like latter-day Ponce de Leons, however, these women are watching their dream of eternal youth fade away. A large, federally funded clinical trial, part of a group of studies called the Women's Health Initiative (WHI), has definitively shown for the first time that the hormones in question--estrogen and progestin--are not the age-defying wonder drugs everyone thought they were. As if that weren't bad enough, the results, made public last week, proved that taking these hormones together for more than a few years actually increases a woman's risk of developing potentially deadly cardiovascular problems and invasive breast cancer, among other things.
As with any major medical announcements, there are caveats and complications. The WHI wasn't designed to look at short-term use during menopause, for instance. But the principal message is this: taking estrogen and progestin for years in the hope of preventing a heart attack or stroke can no longer be considered a valid medical strategy. (For a detailed look at the pros and cons of hormone therapy for various conditions, see the chart on pages 38 and 39.)
Here at last is a rare moment of clarity. The debate over the long-term benefits and risks of HRT has lasted for decades. Now we have at least a few concrete answers.
The findings are so striking that the study was stopped three years short of its scheduled completion. (The other WHI trials, which include a look at how estrogen alone affects women with hysterectomies, are still proceeding.) And the formal scientific report, which is being published in this week's Journal of the American Medical Association, was released a week early at a press conference in Washington.