Hormone replacement therapy can save lives

Photo by Callie Richmond

The headlines about hormone replacement therapy in the summer of 2002 practically screamed.  “Millions in HRT danger.” “HRT can double risk of breast cancer.” “HRT linked to cancer and stroke; doctors demand drug restrictions.”

It was a chain reaction.

First, the federal government published a bombshell study (the Women’s Health Initiative, or WHI) on hormone replacement therapy. Next, the news media launched a fusillade of frenzied coverage. In response, millions of panicked women immediately stopped their own hormone therapy. The New York Times reported that concerned women overwhelmed doctors’ phone lines when news of the study broke.

The fallout continued unabated.

Before the study, 90 percent of women who had undergone hysterectomies were on HRT to treat hot flashes, night sweats, disrupted sleep and other symptoms common to women in their 50s. By 2015, only 40 percent of women were being prescribed such therapy after hysterectomies and only a quarter of them were still on HRT ten months after their surgery. The impact of the 2002 study was clearly far reaching.

Eleven years later, a group of scientists skeptical of the how the 2002 study was conducted published a study of their own.

“We estimated that over the past decade, due to a wholesale abandonment of all forms of hormone replacement for all categories of women by both the women themselves and their doctors, minimally 20,000, and quite possibly more than 90,000 women have died prematurely,” wrote David L. Katz in a July 2013 LinkedIn post. “We were very careful to incorporate only reliably conservative figures into our formula, so the numbers might actually be higher still. Being extremely cautious, we report that over 40,000 women have died over the past ten years for failure to take estrogen.”

That equates to roughly 3,400 Texas women, given that Texas is home to about 8.6 percent of the U.S. population.

At the very least, it’s safe to say millions of women who shunned HRT after the 2002 study have needlessly suffered with the debilitating symptoms of menopause. 

Katz and Philip M. Sarell published their work in the American Journal of Public Health. Katz is director and co-founder of Yale University’s Prevention Research Center. Sarell is professor emeritus of obstetrics, gynecology and reproductive sciences at Yale. They are widely respected and heavily credentialed leaders in their fields.

Katz wrote that “…when HERS (the Heart and Estrogen/progestin Replacement Study) and the WHI tarred the practice of hormone replacement, it was with a broad brush. The news was not that Prem/Pro, one questionable approach to hormone replacement, resulted in benefits for some women and harms for others, with a very slight net harm at the population level. The news was: hormone replacement therapy harms women!”

But the 2013 study was akin to corrections that news outlets frequently publish or broadcast to clear up previously reported mistakes; the updates and corrections often get a tiny fraction of the attention showered on the original, blockbuster headlines.

That is a great injustice.

What else should we call it when such an epic breakdown in scientific rigor leads directly to the avoidable suffering of tens of thousands of women? Women who could have experienced higher quality of life, at minimum, had they been on a therapy regimen that was so wrongly tarred as universally dangerous. 

Like countless other physicians who treat women dealing with menopause and pre-menopause issues, since 2002 I have counseled literally thousands of women on the grossly sloppy way the 2002 study was conducted and reported.

But correcting  the WHI’s colossal blunder is a huge educational battle. Women, as well as medical school students, have been told for years that HRT is to be avoided. Period. Case closed. Very few have heard about the 2013 Sarell and Katz study that should have changed more minds by now.

It’s past time for physicians, academics and the news media to right the wrongs of the past 16 years. The 2002 Women’s Health Initiative study created a false narrative that became accepted, indisputable “truth.” And thousands of women every year are paying the price.

The actual truth, backed by extreme scientific rigor, is that HRT is a life saver and life changer when applied properly. The women in our lives deserve to know.