Menopause hormones don't shorten lives, long follow-up says

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Health outcomes have been previously reported but the earlier reports did not focus specifically on all-cause mortality and cause-specific mortality.

However, an 18-year follow-up of 27,347 women who were part of the WHI study found that they were no more likely to die of any cause than women who took placebo pills.

After 18 years, which included 10 to 12 years of follow-up after stopping hormone therapy, the differences by age group diminished and were no longer statistically significant.

"Hormone therapy is very reasonable for treatment of hot flashes, menopausal symptoms among women who have impaired quality of life due to these symptoms and especially if they're in early menopause", said Dr. Joann Manson of Brigham and Women's Hospital.

As reported in JAMA, when data were pooled for the overall cohort, all-cause death was 27.1% in the hormone therapy group, compared with 27.6% in the placebo group. As the ovaries curb production of the hormones estrogen and progesterone in the years leading up to menopause and afterward, women can experience symptoms ranging from irregular periods and vaginal dryness to mood swings and insomnia.

According to the findings, most deaths occurred after women stopped taking hormones.

But about 18 years of follow-up showed that despite those risks, women had similar rates of deaths from heart disease, breast cancer and all other causes as those who took dummy pills. At first, the replacement hormones-mostly a combination of estrogen and progestin to replace what the body stops making after menopause-were seen as a panacea.

Death rates were similar among women on both types of hormone treatment versus dummy pills. For some women already facing health risks, the potential harms of hormones may outweigh any benefits, and discussions with a doctor about starting the treatment are advised.

"All women should be assessed at menopause for symptoms; bone health, sexual health and their overall medical condition and then be individualized and we have both hormonal and non-hormonal options for women", said Thacker.

With additional years of follow-up, it also appears that the increased heart attack risk associated with HRT in the initial results from the WHI trials is limited to older women, McNeil added.

More research is necessary on the long-term benefits and risks of newer hormone therapies, the researchers say.

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