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Hormone Replacement Therapy Truth: It's Not All Bad

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Hormone Replacement Therapy Truth: It's Not All Bad

Veltman Op-Ed in National Review Online

Hormone Replacement Therapy has been all over the news since a recent trial revealed that HRT comes with some significant health risks. The trial, funded by the Women's Health Initiative, was terminated prematurely after its safety-monitoring board found HRT responsible for a 26-percent increase in breast-cancer incidence. Even women who have taken estrogen and progestin for decades have consequently decided to forego treatment for postmenopausal symptoms altogether, after learning of HRT's supposed carcinogenic properties. Similarly, the drug industry is now forced to consider the possibility of liability for any serious medical condition incurred while on HRT.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

However, while WHI's study is as thorough an examination of the risks of HRT as we are likely to see, the logic behind its conclusions leaves a bit to be desired. The most oft-repeated finding of the study is that HRT resulted in a 26-percent increase in breast-cancer incidence. While this is alarming, the relevance of that statistic is mitigated by less-publicized details. Although the study found a 26-percent increase in breast-cancer incidence, it also found a 37-percent decrease in colorectal cancer and a 17-percent decrease in endometrial cancer. There was therefore actually a two-percent decrease in total mortality rates of HRT patients and only a three-percent increase in total cancer incidence, which is essentially negligible.

In fact, a majority of recent studies have found induced abortion to cause a similar increase in breast-cancer incidence (20-31 percent). However, many of the same critics now labeling HRT as a carcinogenic nightmare perpetrated by the drug industry found it equally convenient to disregard the dangers of induced abortion.

Moreover, although the WHI did study approximately 16,000 women, it did so only for an average of 5.2 years per person. This is lengthy by medical-study standards, but wholly insufficient to judge the effects of a treatment taken for several decades by many women. HRT has been proven to reduce the debilitating effects of osteoporosis, and one can only speculate as to what therapeutic benefits this provides to women who remain much more robust in their old age than previously was possible. Even in just the short timeframe of the study, HRT was found to reduce hip fractures by 44 percent. It may well be that HRT's value increases steadily over time.

The most deficient aspect of the findings by the WHI though, is that although the study was meticulous in examining the various potential complications or HRT, it makes no attempt to quantify, or even acknowledge, the relief HRT grants to postmenopausal women. Although HRT has been labeled as a cure (often mistakenly) for everything from heart disease to Parkinson's Disease, most women take it primarily because of the relief it grants from the symptoms of menopause. HRT has been as effective as promised in relieving women of hot flashes, cramps, and many other encumbrances. The WHI however, has chosen to scrutinize the risks of HRT while totally ignoring its most basic advantages. Given such an environment, very few of today's most common medications would pass the test. Aspirin, Prozac, and Viagra certainly wouldn't.

As one long-time HRT user who was diagnosed with breast cancer at age 70 said, "I would still prefer the high quality years I have had and, to an extent, am still having even breast-less — to the long, drawn-out miseries of the symptoms that once plagued me."

WHI's study is certainly worth considering when determining the relative merits of HRT, but it should by no means disqualify HRT from remaining the treatment of choice for the relief of the symptoms of menopause.