Decline In Estrogen Therapy Linked To Deaths In Women With Hysterectomies

The precipitous decline in estrogen therapy after the 2002 report of its dangers may have led to the deaths of almost 50,000 women who do not have a uterus, according to a new study by researchers at Yale School of Medicine. These findings were published in the July 18 issue of the American Journal of Public Health.

The 2002 Women’s Health Initiative (WHI) study linked estrogen therapy with significant increases in breast cancer, heart disease, stroke and blood clots. Before this study, 90 percent of women between the ages of 50 and 59 used estrogen therapy to treat menopausal symptoms such as hot flashes and to prevent osteoporosis. Today, only 10 percent of women in this age group use this therapy.

For the current study, led by Philip Sarrel, MD, emeritus professor in the Departments of Obstetrics, Gynecology & Reproductive Sciences, and Psychiatry, the researchers analyzed United States census data, hysterectomy rates, and estimates of decline in hormone use in women aged 50 to 59 between 2002 and 2011.

While the WHI report distinguished between those with and without a uterus, the public at large did not pick up on the distinction, and millions of women simply avoided estrogen therapy altogether, even in situations where its benefits would have outweighed its risks.

The culprit linked to increases in breast cancer and other diseases is a second hormone called progestin, which is needed in conjunction with estrogen by women who have not had a hysterectomy in order to avoid an increased risk of uterine cancer.

Since women without a uterus have no need to take the additional hormone, their continued use of estrogen-only therapy remains almost completely beneficial. A series of papers which were published by the WHI between 2004 and 2012 confirmed this by following women who had no uterus and who took either estrogen-only or placebo.

“For example, in 2011 and 2012 the WHI reported that women who received estrogen compared to those who received placebo had fewer deaths each year for 10 years and were less likely to develop breast cancer and heart disease. For each of the 10 years the death rate among those not taking estrogen was 13 more per 10,000. Most of these women died from heart disease while breast cancer accounted for almost all the other deaths.”

Sarrel concludes, “Estrogen avoidance has resulted in a real cost in women’s lives every year for the last 10 years – and the deaths continue. We hope this article will stir an overdue debate and raise consciousness about the health benefits of estrogen-only therapy for women in their 50s with no uterus.”