Study finds
hormone-mixing riskA study with isle data finds
using estrogen and progestin
doubles the odds of dementia
Women who are taking estrogen plus progestin to prevent various diseases instead are increasing risk of dementia, stroke from clots and other health problems, a national study has found.
The risks are small, but there aren't enough positive benefits to balance them, said Dr. J. David Curb of the Pacific Health Institute.
"We're seeing negative effects instead of positive."
Curb is principal investi-gator in Hawaii for the Women's Health Initiative, a national clinical study of women's health issues. The institute is one of 40 centers participating.
A memory study conducted as part of the larger program found the risk of developing dementia may be doubled in older women who take combined estrogen and progestin.
The study, reported yesterday in the Journal of the American Medical Association, included 4,532 postmenopausal women age 65 and older.
In Hawaii, 99 women participated in the memory study, said Dr. Kamal Masaki, principal investigator. The women included 36 on estrogen and 63 on a combination of estrogen and progestin, although some women in both groups were given placebos, or substitutes for the drugs.
Two women developed dementia, Masaki said. One was in the estrogen-progestin group and it isn't known if she was taking the drugs or placebos. The other patient was in the group taking estrogen or placebos.
The estrogen study is continuing, but the estrogen-progestin program was stopped last July after findings that the combined hormones increased risks of breast cancer, strokes and cardiovascular disease.
Risks were reduced for fractures and colon cancer.
"Not everybody believes these results and it's a worldwide issue," Curb said. "Debates are going on."
But evidence is weighing on the side that the combined hormones aren't beneficial, he said.
The Food and Drug Administration said hormone use remains approved for younger women to relieve menopausal symptoms such as hot flashes and night sweats, but they should consult with their doctors.
Also, if appropriate, they should take the lowest possible dose for the shortest time, the FDA said.
Wyeth Pharmaceuticals, which supplied the drugs for the study, reported the memory findings on its Web site yesterday, saying it has updated labeling for its hormone therapy products to incorporate them.
Curb said doctors have been practicing with the best available data, but recommendations have changed.
Based on the latest findings, investigators say older women should avoid estrogen and progestin in order to prevent dementia or protect against memory loss and women should talk to their doctors about the findings before starting combined hormone therapy.
Letters have been sent to about 400 Hawaii women and their doctors advising them, "For every 10,000 women taking estrogen plus progestin pills: 45 developed dementia each year compared to 22 dementia cases each year for every 10,000 women taking placebo pills."
Curb said there is a lot of speculation that progestin may be the culprit in the combined drug therapy rather than estrogen.