The Hormone Debate

The latest analysis of data from the Nurses' Health Study (NHS) suggests that hormone therapy is associated with an increased risk for stroke, regardless of the treatment strategy or the timing of treatment initiation.

This is concerning since hormone therapy was once touted to have protective benefits and physicians were encouraged to place women on hormones for the cardiovascular and bone benefits.

Now as with many other drugs and therapies, the follow-up studies are not always supporting the “science”.

This study found an increased risk of approximately 40% with estrogen alone and 30% with estrogen plus progestin and is nearly identical to that of the Women's Health Initiative study.

This NHS is a prospective, observational study including 121,700 women who were between the ages of 30 and 55 years in 1976 and the subjects were observed with biennial questionnaires, including information on menopause and postmenopausal hormone use as well as cardiovascular risk factors and cardiovascular diagnoses.

Overall, this is a large sample group with good observational data and the bottom line results are:

• Use of hormone therapy by postmenopausal women is associated with overall increased risk for stroke of 30% to 40%.

• An increased risk for stroke associated with hormone therapy use in postmenopausal women is independent of age of initiation of hormone therapy and greater with higher doses of estrogen and older age.

Once again, there are no “free rides” and risks vs. benefits must always be assessed.