COMMENTARY

Hormone Therapy: All We Have to Fear Is Fear Itself

Wholesale Avoidance of HT Can Have Negative Public Health Consequences

Andrew M. Kaunitz, MD

Disclosures

August 21, 2013

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Mortality From Avoiding Estrogen in Hysterectomized Women

In the 1990s, more than 90% of hysterectomized women in their 50s used estrogen therapy (ET). Following the initial publication of findings from the estrogen/progestin therapy Women's Health Initiative clinical trial in 2002, the use of hormone therapy declined substantially. Currently, some 30% of women post-hysterectomy use ET.

The ET-alone Women's Health Initiative trial found that among women aged 50-59 years, ET reduces mortality compared with placebo. Although most of this reduction in mortality was the result of fewer deaths from coronary heart disease, declines in breast cancer mortality were also observed.[1,2]

In a recent issue of the American Journal of Public Health,[3]investigators calculated the excess mortality among US women aged 50-59 years as a consequence of nonuse of ET during the decade from 2002 through 2011. Estimates of excess premature mortality attributed to nonuse of ET in this population for these 10 years ranged from 9000 to 92,000 women.

By pointing out the negative health consequences of the declines in estrogen use among US menopausal women who have undergone hysterectomy, Dr. Phillip Sarrel and his colleagues at Yale University and in Italy have performed a valuable service to women's health clinicians and our patients.

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