Although "experts appear to be uniting" behind the recommendation that hormone replacement therapy is a "reasonable option for younger menopausal women with severe symptoms," evidence suggests that some women are not receiving the advice, the Los Angeles Times reports (Roan, Los Angeles Times, 7/23). According to the health care information company IMS Health, HRT sales have declined 30% since findings from the 15-year, $725 million NIH-sponsored Women's Health Initiative study were published.

NIH researchers in July 2002 ended the WHI study on combination HRT three years early because they determined that the treatment might increase the risk for heart disease, invasive breast cancer and other health problems. A later WHI analysis, published in the April 4 issue of the Journal of the American Medical Association, found that HRT use among women in their 50s does not increase their risk for heart attack.

In addition, a study published last month in the New England Journal of Medicine found that women in their 50s who took estrogen on a regular basis were 60% less likely than those who took a placebo to have large amounts of plaque in their arteries, an indicator of heart attack risk. Participants who took estrogen were 30% to 40% less likely than those who took a placebo to have large amounts of plaque in their arteries. However, participants who took estrogen had a higher risk for stroke than those who took a placebo, according to the study (Kaiser Daily Women's Health Policy Report, 7/9).

According to Marcia Stefanick, chair of the WHI executive committee and a professor at Stanford University, it is not known if younger menopausal women taking estrogen plus progestin reduce their risk of having large amounts of plaque in their arteries. "The data don't apply to that group," Stefanick said, adding, "They apply to women who specifically had a hysterectomy and had their ovaries removed. These weren't women who started hormones at the time of menopause. I think it would be a mistake to extrapolate that."

The additional data still are evidence that cardiovascular effects of hormones differ in women depending on age, Jacques Rossouw, chief of the WHI branch at the National Heart, Lung and Blood Institute, said. "Taking those studies together, we can say there doesn't appear to be any increased risk of cardiovascular disease in younger women," Rossouw said, adding, "And that is reassuring for women who want to use it for four or five years." However, Rossouw added, "It's not OK to use hormones for symptom relief at older ages."

Wulf Utian, executive director of the North American Menopause Society, said that many women still have an inflated view of the risks of taking HRT. According to IMS Health, HRT sales have continued to decline every year through 2006 after a steep decline in sales in 2002. Stefanick said, "The biggest problem is, if you start, when do you stop? I think the whole physiology of hot flashes needs more research" (Los Angeles Times, 7/23).

Los Angeles Times Examines Alternative HRT Treatments
The Times on Monday profiled current research being conducted on alternative treatments to HRT for hot flashes and other menopausal symptoms. According to the Times, none of the drugs has undergone clinical trials that "match the vast scale, scope and duration" of estrogen studies (Shekhar, Los Angeles Times, 7/23).