Estrogen Avoidance Results in Unnecessary Deaths

A new study calculates that rejecting estrogen-only hormone replacement therapy (HRT) has resulted in the early deaths of nearly 50,000 women.

Researchers at Yale University (New Haven, CT, USA) and Universita di Firenze (Florence, Italy) conducted a study that examined the effect of estrogen avoidance on mortality rates among hysterectomized women. To do so, the researchers derived a formula to relate the excess mortality in hysterectomized women aged 50 to 59 years assigned to placebo in the Women’s Health Initiative (WHI) randomized controlled trial to the entire population of comparable women in the United States, incorporating the decline in estrogen use observed between 2002 and 2011.

The results showed that over the 10-year span, a minimum of 18,601 and as many as 91,610 postmenopausal women aged 50 to 59 years died prematurely due to the avoidance of estrogen HRT. When the researchers examined mortality rate data in a separate group of women than those followed in the WHI 2002 trial, their analysis further estimated that between 40,292 and 48,835 women died prematurely during the study period. The study was published online ahead of print on July 18, 2013, in the American Journal of Public Health.

“Distortion of details can prove to be nothing less than lethal. What has happened is an avoidance of use of estrogen not because of the findings, but because of the way they were communicated and understood,” concluded lead author Emeritus Prof. Philip Sarrel, MD, of Yale, and colleagues. “None of those women lived to be 70 years old. They were all women aged 50-59 who would have used estrogen but did not use it because of unfounded fears.”

Prior to 2002, 90% of US women who had had hysterectomies used HRT estrogen therapy for around five years. But those numbers have plummeted since the WHI cut short its Estrogen Plus Progestin Trial in 2002, when study results revealed that women who took the two-hormone therapy suffered adverse effects and higher mortality. Today, less than a third receive HRT, even though ongoing studies by the WHI in 2004 and 2011 have shown that women took estrogen alone actually had a decreased risk of early death compared to women taking a placebo, mostly due to reduced incidence of heart disease.

Related Links:
Yale University
Universita di Firenze