“No link between hormone therapy and all-cause or cause-specific death rates in the
Women’s Health Initiative
Those of us who have practiced gynecology as long as I remember very well the day that the Women’s Health Initiative (WHI) results were made public. It was July, 2002, and the news was unexpected. The Women’s Health Initiative was a study started in 1994 to determine if hormone therapy (given as conjugated equine estrogen and medroxyprogesterone acetate) would prevent cardiovascular disease in women between the ages of 50-80. Previous data were consistent with cardiovascular benefits for women who took hormones, so this study was initially hopeful. Instead, the initial data demonstrated that there were more heart attacks, strokes, blood clots, and breast cancer in women on the therapy. There were less osteoporotic fractures and colon cancer, but the risks outweighed the benefits. That day, many women stopped hormones and chose to tolerate their menopausal symptoms, rather than accept these additional risks.
In the last 15 years, the researchers have continued to collect data, and stratified the results related to age. Women in their 50’s had fewer risks than women in their 70’s. In the last 15 years, there has been broader use of transdermal estrogen and bioidentical progesterone, which may have a different safety profile. Many years later, researchers compared mortality statistics for women who took hormones in the WHI, vs. women who were taking placebo.
The study reported today in the Journal of the American Medical Association, looked at mortality rates for women who participated in the WHI.
Among 27,000 women who were randomized to hormones or placebo who on average took hormones for 5-7 years, and were followed up for 18 more years, the mortality rates were statistically equivalent. This included mortality for all causes, including heart disease and cancer.
Although it is not recommended that women take hormones to prevent chronic diseases, this data suggests that if women choose to take hormones to help them through the menopausal transition, long-term mortality rate is not affected. This is good news!
A decision to take hormone therapy is an individual decision made by a women and her physician, taking into account her medical history, physical findings, and family history.
Marilyn Jerome, MD
Foxhall OB-Gyn Associates
JAMA, 2017: 318 (10), 927-938
Menopausal Hormone Therapy and Long-Term All-Cause and Cause-Specific Mortality,
The Women’s Health Initiative Randomized Trials, JoAnn Manson, MD, DrPH, Aaron K. Aragaki,MS, Jacques E. Rossouw, MD, et al
Did you ever consider that working may be beneficial to your health? There is now data that demonstrates that working longer may increase your longevity.
In 2016, a study was published in the Journal of Epidemiology and Community Health which demonstrated that healthy people who retired one year later than those in the control group, decreased their risk of dying during the study period, which lasted 18 years, by 11%. Retirees who had health problems also lived longer if they postponed their retirement. A French study linked later retirement with a decreased risk of dementia and Alzheimer’s disease.
It could be that a job that you enjoy may be associated with more social connections, increased physical activity, and provide a purpose, creative outlet or a challenge. All of these factors have been associated with improved health.
Not all studies agree. In an Australian study published in the Journal of Economics, researchers
linked overall health to longevity, with no benefit of a later retirement. Of course, health problems my be a reason that people retire, a factor that may affect some of the study models. Your work environment may make the difference. A person who works in a positive work environment that is challenging and fulfilling may have very different health effects than a person who works in an environment that is stressful or hostile, causing physical or psychological stress.
Many women in their later working years need a change. They may choose to take advantage of more flexible work schedules such as working part-time or working from home when possible. Finding a position that is less demanding, with less management responsibility can often decrease stress. Some women may look at their careers, having achieved their goals, and switch careers entirely, doing something different that arose from an interest, hobby, or previous work experience. Becoming a consultant in your field offers an opportunity to use your skills and contacts, and manage your work schedule as you wish.
Dr. Nicole Maestas, who is an associate professor of health care policy at Harvard Medical School, feels that working longer can increase financial security and in some cases, improve health. She believes that women should try to remain engaged in the workforce as long as possible.
When to retire is a complex decision which depends on many factors including finances, health, and a person’s individual work situation. Now it appears that there is at least some data that working longer may be good for your health!
Harvard Women’s Health Watch, Volume 25, Number 1, September 2017
It used to be that you would take an aspirin if you had a headache or pain. Then doctors began to appreciate that aspirin could prevent strokes and colon cancer. Many studies now look at the benefits of taking aspirin preventatively. But is it right for you?
Although there are benefits to taking aspirin, there are risks also. Aspirin can irritate the stomach and cause gastrointestinal bleeding and stomach pain. People who take aspirin may bleed or bruise more if they are injured. As in many medical decisions, the risks and benefits must be weighed.
Your doctor should evaluate your risk factors for heart disease and stroke, and weigh them against risks of bleeding that include uncontrolled hypertension, ulcers, or other conditions that make it more likely you might bleed. For those with a history of a heart attack or documented coronary artery disease, and without risks of bleeding, benefits usually outweigh the risks. The use of aspirin for those without documented heart disease is another question. There is evidence to support using aspirin in adults aged 50-59 who have a 10% or greater risk of heart disease in the next 10 years. For those under the age of 50, or older than age 70, individual risk factors need to be assessed.
To prevent colon cancer, it seems that one must take aspirin for 5-10 years before the benefit becomes apparent. There is some evidence that aspirin may decrease breast cancer risk, but not enough evidence to recommend it at this time.
An app has been developed by Dr. JoAnn Manson and her colleagues the Brigham and Women's Hospital in Boston. The app is called Aspirin Guide and it is free.The app is meant to help clinicians determine if low dose aspirin for the primary prevention of atherosclerotic cardiovascular disease. The app uses patient specific information to determine scores for the risk of heart disease and bleeding. It asks for your age, sex, history of gastrointestinal bleeding, blood pressure and cholesterol levels, and certain medications. It is very easy to use, and is a good starting point for a discussion with your physician.
Marilyn C. Jerome, MD
Harvard Women's Health Watch, Volume 25, Number 1, September 2017
Aspirin Guide, an app developed at Bringham and Women's by Samia Mora, MD,
JoAnn Manson, MD, and Jeffrey Ames, BS