HRT
Linked to Increased Stroke Risk
Estrogen-progestin
combination appears to increase most women's risk, study concludes
The first jolt came less
than a year ago, when a national study revealed that combined hormone
therapy would not protect a woman from heart disease as previously
believed.
Now a new analysis of
that same research has found the estrogen-progestin combination
also appears to increase a woman's risk of stroke, in some instances
by as much as 70 percent. The increases were not just limited to
women with high blood pressure, which is a known risk factor for
stroke.
"We saw an increase in
stroke in all postmenopausal women across the board, in healthy
women and in women with high blood pressure, in younger women and
older women," says study author Sylvia Wassertheil-Smoller, a professor
of epidemiology and social medicine at Albert Einstein College of
Medicine in New York City. "There is no doubt in my mind that the
use of the estrogen/progestin combination should not even be considered
as a strategy for protecting a woman's health."
Smoller's research is
a re-analysis of data previously released from Women's Health Initiative
(WHI), a study designed to examine the health effects of hormone
replacement therapy (HRT). Although slated to last eight years,
part of the trial ended after five when sufficient data showed combined
hormone therapy not only failed to protect women, but also appeared
to increase health risks, particularly for cardiovascular disease.
The estrogen-only arm of the study is continuing.
The new analysis was devised
to see whether the same links appeared in relation to stroke. The
researchers looked at data on 8,506 women aged 50 to 79, all of
whom received the combined estrogen/progestin therapy. The control
group was comprised of 8,102 women of the same age who took a placebo.
The study also took into
consideration the women's ages, race, blood pressure status, and
baseline risk for stroke, none of which were detailed when WHI was
halted last year.
The
End Result
Overall, researchers saw
133 strokes in the group taking the hormones, compared to 93 in
the control group. Women aged 50 to 59 who were taking hormones
had the most dramatic increases in strokes—as much as 70 percent
over the control group. Those aged 70 to 79 saw the least risk—only
26 percent.
The most surprising finding
of all, Smoller says, was that even in women who had no history
of heart or blood vessel disease, stroke rate climbed by 40 percent
when the combined hormone therapy was used.
Conclusions
Spark Controversy
Not everyone agrees with
the conclusions, which were presented at a recent American
Heart Association International Stroke Conference in Phoenix.
For gynecologist Dr. Steven
Goldstein, the new analysis has serious flaws and its conclusions
are premature. Among the most obvious problems, he says, is the
lack of information concerning other risk factors for stroke, particularly
in women with normal blood pressure.
"The study cannot tell
us, for example, if these women might have had high cholesterol,
if they smoked, if they were overweight—all factors that could
have easily influenced the risk of stroke, irrespective of hormone
use," Goldstein says.
He adds that unless researchers
can say for certain that these other mitigating factors were not
present, then it is impossible to link the incidence of stroke to
hormone use in any kind of meaningful way.
"It is very unfair to
women to draw conclusions that create fear without sufficient proof
that there is even cause for alarm," he says.
While physicians are not
certain how or why the combination of estrogen and progestin appears
to increase stroke risks, Smoller believes individual bio-markers
and genetic fingerprints may play a role.
According to the American
Stroke Association, almost 100,000 women die of stroke
each year, almost twice as many as from breast cancer.
Always consult your physician
for more information.
Online
Resources
(Our Organization is not
responsible for the content of Internet sites.)
American
College of Obstetricians and Gynecologists
American
Heart Association
American
Stroke Association
Centers
for Disease Control and Prevention (CDC)
National
Institutes of Health
National
Women's Health Information Center
|
March
2003
Estrogen-Progestin
Combination Appears to Increase Most Women's Risk, Study Concludes
The
End Result
Conclusions
Spark Controversy
New
Birth Control Pills Do Not Lower Stroke Risk
The
Nuisance of Hot Flashes
Online
Resources
In Other Women's Health
News:
New
Birth Control Pills Do Not Lower Stroke Risk
Despite lower levels of
estrogen, the new generations of birth control pills double the
risk of stroke for women who take them, a new study shows.
In the first look at the
risk of ischemic strokes from the latest generation of oral contraceptives,
Dutch researchers say the newest pills are no safer than the older
versions when it comes to clotting problems. In fact, they argue,
the third-generation pills may be more dangerous than the second-generation
ones.
The history of oral contraceptives
has been one of trial and error.
The first generation of
pills, introduced in 1960, was a mix of high doses of estrogen and
one of two other hormones, lynestrenol or norethisterone, also known
as progestogens. However, they increased the risk of clotting, which
can lead to ischemic stroke. The next version, released in the 1970s,
contained markedly less estrogen and only the progestogen levonorgestrel.
This combination also
raised the risk of stroke, especially in smokers and women with
high blood pressure. In addition, women complained of side effects
from levonorgestrel, including acne, cholesterol problems, and weight
gain.
Hoping for the best, pill
makers issued yet another formula in the 1980s that combined low
estrogen levels with the less harsh progestogens desogestrel or
gestodene.
Third-generation birth
control pills have not been used in the United States long enough
to monitor women most at risk for stroke. However, Europe approved
them sooner, letting researchers there compare risks among all three
kinds of pills.
A team led by Jeanet M.
Kemmeren, an epidemiologist at University Medical Center in Utrecht,
looked for a link between oral contraceptives and ischemic strokes
in nearly 1,130 women, aged 18 to 49, of whom 203 had suffered one
such attack.
Always consult your physician
for more information.
The
Nuisance of Hot Flashes
Reducing Their
Severity Without HRT
Hot flashes—one
of the more unpleasant symptoms of menopause—are related to
a drop in estrogen levels. Hormone replacement therapy (HRT) had
often been prescribed to prevent them, but with the recent controversy
surrounding HRT, other, symptom-relieving strategies are offered
below:
According to the National
Women's Health Information Center, the following lifestyle
changes may help reduce the severity or frequency of your hot flashes:
-
Drink a cool glass of water at
the beginning of a hot flash.
-
Avoid alcohol or caffeinated
drinks. These chemicals increase the discomfort of hot flashes.
-
Cut down on red wine, chocolate,
and aged cheeses. They contain a chemical that can trigger
hot flashes by affecting the brain's temperature control.
-
Do not smoke—as smoking
often aggravates hot flashes.
-
Wear loose, comfortable, cotton
clothing.
-
At home, lower your thermostat;
at work, carry a small portable fan.
-
Sleep with lightweight blankets.
-
Dress in layers, so you can remove
some clothing if you suddenly feel hot.
Always consult your physician
for more information.
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