Estrogen therapy has long been debated. And in fact, the usage of estrogen therapy among U.S. women dropped significantly after the Women's Health Initiative (WHI) study in 2002 showed that it could increase the risk of cancer and other health issues. But a new report out of Yale University and published in the American Journal of Public Health shows that not using the hormone treatment has led to almost 50,000 premature deaths over a period the last 10 years in women aged 50-59.
Before 2002, women who received a hysterectomy (i.e., a removal of their uterus) were almost always also treated with estrogen therapy — after a hysterectomy, women tend to go into menopause earlier, and estrogen therapy can help manage related symptoms. More than 90 percent of the women took the therapy to prevent hot flashes and osteoporosis. But the trends have shifted, and today only 10 percent of women in this category use the treatment.
The problem, though, is that estrogen therapy does more than simply relieve menopause symptoms. Estrogen therapy typically was administered alongside a second hormone: progesterone. And earlier studies showed that progesterone significantly lowers the risk of uterine cancer, which women who have no uterus do not have to worry about.
The researchers who conducted the current study blame the fact that people do not know that the original study which. In addition, they state that the results of the WPI study are not relevant to women who have had hysterectomies.
"Sadly, the media, women, and health care providers did not appreciate the difference between the two kinds of hormone therapy. As a result, the use of all forms of FDA-approved menopausal hormone therapy declined precipitously." said Philip Sarrel, M.D., emeritus professor in the Departments of Obstetrics, Gynecology & Reproductive Sciences, and Psychiatry who led the study.
Follow-up studies by the WHI showed that estrogen-only therapy for women who had their uterus removed resulted in positive health outcomes. In 2011 and 2012, the WHI reported that women without a uterus who were on estrogen therapy had fewer deaths compared to women who took a placebo treatment. These women also had a lower incidence of breast cancer and heart disease.
"Estrogen avoidance has resulted in a real cost in women's lives every year for the last 10 years — and the deaths continue," said Sarrel. "We hope this article will stir an overdue debate and raise consciousness about the health benefits of estrogen-only therapy for women in their 50s with no uterus."
The paper concludes that "informed discussion between these women and their health care providers about the effects of ET [estrogen therapy] is a matter of considerable urgency."
To view a video explaining the findings click here.
Source: Sarrel P, Njike V, Vinante V, and Katz D. The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years. American Journal of Public Health. 2013