Confusing News About Hormones and Stroke

Women are once again getting the bad word on hormone replacement therapy, with a new study linking HRT to strokes. Previous research had left a glimmer of hope that hormones didn't harm the cardiovascular system if they were taken at the beginning of menopause, a year or so after a woman's last period, rather than a decade or two later. But this new study calls that into question.

I find it ironic, though, that the study published this week in the Archives of Internal Medicine was based on data from the Harvard Nurses' Health Study—the very same study that years ago linked hormone use to all kinds of health benefits: protection against heart disease, Alzheimer's, colon cancer, and, yes, even strokes. The study has been tracking the health of more than 120,000 nurses over the past 30 years to see which particular health habits are beneficial and which detrimental. (As you can imagine, there's a lot of room for error even in this highly respected study.) Funny how the researchers, who are among the top epidemiologists in this country, have now come up with a completely different result that, as they write in the journal paper, is "nearly identical to that of the Women's Health Initiative." For those not familiar with WHI, it was the trial in which women were randomly assigned to take hormones or placebos to see whether hormones could prevent all those diseases of aging. As it turns out, WHI found that HRT caused more illness than it prevented.

The Nurses' Health researchers are doing a bit of a two-step to explain how this new study jibes with their earlier findings: that HRT led to nearly a 50 percent decrease in stroke rates. For one thing, they explain, this new study didn't find an increased risk of strokes in young women who took HRT for less than five years. What's more, women had no increased risk if they took a low dose of estrogen (0.3 milligrams), a dose that was found to be protective against strokes in their earlier study.

The low dose happens to be what's now usually prescribed for women suffering from hot flashes, night sweats, and other menopausal symptoms. So there's no need to panic, and no need to stray from the current accepted wisdom to take the lowest possible hormone dose for the shortest possible time. If you're having difficulty deciding whether or not to take hormones, check out how these women solved their HRT dilemmas.