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Hormone Hell
By Melissa Hendricks
Now they tell us! Hormone therapy isn't the wonder drug that will keep us young forever.
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Lynne McKelvey was furious when she first heard the news in July. Hormone replacement therapy (HRT), touted as a panacea for years, suddenly was thought to do more harm than good.
The 66-year-old Pepperdine University English professor had been taking a combination of estrogen and progestin for a decade. And now, the government was calling a halt to a huge clinical trial of HRT—her medicine—because of increased rates of breast cancer, heart disease, stroke, and blood clots in women taking the drugs.
"My friends and I talk about this obsessively," says McKelvey. "We knew we were a guinea pig generation, because the drugs hadn't been fully tested. But we never expected this bombshell."
Behind the anger, of course, there's the fear. Her mother and aunt suffered from breast cancer, and here she has been taking a drug that increased her risk of the disease.
McKelvey is not alone. When news of the study broke, some 40 percent of postmenopausal women in the United States were using HRT, including 6 million on combination therapy and another 8 million on estrogen alone. When the National Institutes of Health announced it was stopping the combination HRT trial—part of a huge set of studies called the Women's Health Initiative (WHI)—experts predicted that millions would quit, or at least reduce their dosages. Stock prices for Wyeth plunged; the company produces Prempro, the most popular form of HRT and the one used in the study.
All this, over a drug regimen that, only a few years ago, was considered by doctors to be a trusty weapon in the war against aging. How could this happen? History provides some answers.
Starting in the 1960s, American doctors began prescribing estrogen pills to quell the hot flashes and night sweats, abate the vaginal dryness, and even out the mood swings that affect at least half of all women during menopause, when natural hormone levels decline.
In the 1970s and following decades, doctors began exploring estrogen's ability to prevent chronic conditions, in particular heart disease, the number-one killer of women. They were encouraged by laboratory studies that suggested estrogen might benefit the heart. For example, scientists found that estrogen lowers LDL ("bad") cholesterol and raises HDL ("good") cholesterol.
Over the years, hormone therapy's charms grew. Not only would it guard against disease, it would restore youth, believers claimed. Until recently, many doctors routinely recommended HRT to their menopausal and postmenopausal patients. In one book, a physician-author maintained that estrogen reduced the risk of various cancers, improved memory, alleviated arthritis pain, and made stronger muscles, firmer breasts, younger skin, and healthier hair. "Women were told, 'You'll look better, feel better, you'll be young forever,'" says Nanette Kass Wenger, a cardiologist at Emory University School of Medicine and chair of an international panel that recently conducted a four-year review of the research on menopause.
So it was with a shock that many doctors and scientists learned the latest bad news about hormone therapy. The WHI study caused many to rethink their endorsement of the regimen. Estrogen therapy has many benefits, but it also has greater risks than previously thought, especially for women inclined toward heart disease.
"We painted too rosy a picture," concedes Jacques Rossouw, acting director of the WHI. "Though they were acting on the best medical evidence of the day, the medical professionals and scientific investigators have really not served postmenopausal women well by advocating for the widespread use of hormones for chronic diseases. It should never have been prescribed so widely."
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