Another Blow To Estrogen Therapy

In an editorial in one of the nation's most influential medical journals, a Tufts expert says doctors should rethink the risks of estrogen therapies.

Boston [07.16.02] -- For the second time little more than a week, hormone replacement therapy was dealt a major blow by new research into its long term risks. The newest findings - which tie estrogen therapy to increased risk of ovarian cancer - follow on the heels of last week's news linking hormone replacement to risks of strokes, heart attacks and breast cancer. The scientific evidence, wrote a Tufts expert in an editorial in one of the country's top medical journals, should prompt doctors to rethink their use of the therapy.

"I think you're going to find most physicians and groups like the American College of Obstetricians and Gynecologists are going to start saying there is no indication for the majority of women to be on [hormone replacement therapy]," Kenneth Noller - the chair of Tufts' obstetrics and gynecology department - told the Philadelphia Inquirer. "I think we need to be a whole lot more cautious [in prescribing it]."

Until recently, hormone replacement therapies were routinely prescribed to treat symptoms of menopause and prevent health problems in postmenopausal women including coronary artery disease and osteoporosis.

But Noller says the recent surge in new studies linking the therapies with a host of health problems raises questions about the safety of the treatments that should not be ignored.

"The association between estrogen use and ovarian cancer should be worrisome enough for clinicians to consider carefully whether to suggest estrogen-only hormone replacement therapy," he wrote in the Journal of the American Medical Association editorial, which was covered in news reports around the world.

The safety of long-term use of the hormones, Noller wrote, has been called into question. "Estrogen replacement therapy certainly is not the panacea it once appeared," wrote the Tufts expert.

But scientists have yet to learn why estrogen therapies increase risk of ovarian cancer, Noller -- a doctor at the Tufts-New England Medical Center -- said.

"In general this is one of those times when we have an observation without a good biological basis," he said in an interview with Reuters Health - an international news service. "There seems to be a clear-cut increase in ovarian cancer, but we really don't know why."

While long-term use of the hormones looks increasingly less safe, Noller noted that short-term use of estrogen to treat severe symptoms of menopause still appears to be safe.

"[Women who have] terrible menopausal symptoms should not be afraid to take hormone replacement therapy for a short time," he told Reuters.