Hormone Therapy Debate Reignites as New Understanding Emerges for Women Over 60
NEW YORK, NY – A growing discussion surrounding hormone replacement therapy (HRT) is focusing on the evolving understanding of its risks and benefits, especially for women over the age of 60.A recent exchange with a reader highlights a critical point: a generation of doctors may lack comprehensive training in hormone prescribing, while existing research requires nuanced interpretation.
The debate stems largely from the Women’s Health Initiative (WHI) studies, which initially raised concerns about HRT’s safety. However, a Cornell University physician responding to a reader question emphasized that the interpretation of these studies is key. “I wouldn’t say the studies…were flawed so much; their interpretation needs to include the age of subjects in the study and the intervention given,” the physician wrote in a response published this week.
Specifically, the WHI’s mean participant age of 63 showed a critically important increase in heart disease and stroke risk. however, a re-evaluation of the data suggests a different picture for younger women. “A careful reinterpretation of the data suggested that younger women (aged 50-59 or those within 10 years of stopping their periods) probably had no excess risk of heart disease and may have had a reduction,” the physician explained.
The type of hormone used also plays a crucial role. Current recommendations lean towards estradiol (a bioidentical estrogen) and micronized progesterone (a bioidentical progestin), which are believed to carry a lower cancer risk than the conjugated estrogen and medroxyprogesterone used in many earlier studies. While research on breast cancer risk remains mixed, some studies suggest a reduced risk with estrogen-only regimens.
Crucially, the physician draws a firm line regarding women over 60 and those more than 10 years postmenopausal. “I do not recommend initiating HRT in women who are both over 60 and are more than 10 years postmenopausal due to the increased risk of heart disease and stroke.” HRT is also not recommended for asymptomatic women as a preventative measure.
Beyond heart health, the physician noted other considerations, including potential benefits in reducing colon cancer and fractures, a possible small increase in risk for other cancers, no clear impact on dementia, and a reduction in new diabetes cases.
The physician stresses that a thorough discussion of individual risks and benefits is essential before any HRT decision is made,and that all general gynecologists,as well as many primary care doctors in family and internal medicine,are trained in HRT and should be familiar with the latest data.
Readers with questions can submit them to ToYourGoodHealth@med.cornell.edu.