Recently (Nov. 2014) a study called the ELITE study by Dr. Howard Hodis and his associates at USC was presented at The American Heart Association. This study helps to confirm some very good news for women. If you start taking certain forms of hormone therapy within 6 years of menopause you can very significantly reduce your risk of cardiovascular disease and thus your risk of heart attacks. Each year more than 400,000 women die of a heart attack. It is the leading cause of death in women.
Who should sit up and take notice? All women who are approaching natural menopause, all women who are considering a hysterectomy AND all women who had their last period or had a hysterectomy within the last 6 years. If you wait a decade or more to replace the hormones that your ovaries were making you lose the cardiovascular benefit. If you are not already taking hormone-therapy you should talk with your doctor and consider starting.
Some of the good news in the Nov. report is not brand new. We have known for quite a while that women achieve important health benefits if they start on estrogen-only therapy in the years following hysterectomy. Numerous other studies confirm these results. Even the famous American study called WHI (Women’s Health Initiative) reported that, at follow-up, the women in their estrogen-only group had a decreased risk of heart-disease and, by-the-way, a decreased risk of breast cancer.
If ovaries are removed at the time of hysterectomy, it is usually recommended to start estrogen replacement immediately. If the ovaries are retained, women should have continuing hormone evaluations by their gynecologists as, sooner or later, they too will become estrogen deficient. Only women without a uterus can safely take estrogen without taking a second hormone (progesterone or a progestin) to protect the uterus from cancer.
What IS brand new from the ELITE study is that women who still have a uterus, and thus must take a combined two-hormone regimen, can reap the same cardiovascular benefit as those without a uterus taking estrogen-only. But, to get the cardiovascular benefit, hormones should be started by six years after menopause and certainly before a decade has passed. In the ELITE study the women with a uterus took an estradiol pill for their estrogen and natural progesterone in the form of a vaginal gel 12 days per month. ELITE also showed that women who were 10 or more years from menopause and given the same hormones did not show the cardiovascular benefits.
Although the cardiovascular benefits of estrogen–only therapy are well documented they are not widely appreciated by the general public nor even by many health-care providers; this is due to the impact of the original WHI report in 2002 in which women with a uterus who were given estrogen plus a certain derivative of progesterone (MPA). This combination pill is called Prempro and it is different from the regimen used in the ELITE study. The 2002 study showed that the women taking Prempro had an increase in cardiovascular disease and stroke (as well as breast cancer). It is NOT correct to extend the 2002 Prempro findings to other forms of hormone preparation and certainly not to estrogen-only. But, since 2002 that is just the error made by so many people. The frightening results from Prempro use were over-generalized and all hormones got a bad reputation.
The time has come to rethink the use of estrogen in reducing the risk of cardiovascular disease and breast cancer in women who have had a hysterectomy and the role of combined hormone therapies (other than Prempro) for women with a uterus.