Avoiding estrogen therapy proved deadly for nearly 50,000: study

Beverly Hills pharmacist Sam Sheldon makes a compounded estrogen pill in 2002. A new analysis estimates that nearly 50,000 women who had hysterectomies died prematurely because they avoided estrogen therapy.
(Ken Hively / Los Angeles Times)
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<i> This post has been updated. See below for details. </i>

Hormone replacement therapy has plummeted among U.S. women since the Women’s Health Initiative 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.

But the widespread rejection since of all hormone replacement therapies among menopausal women has been misguided, a team of researchers from the Yale School of Medicine in New Haven, Conn., wrote Thursday in the online edition of the American Journal of Public Health.

Looking at a separate group of women than those followed in the 2002 trial — women ages 50 to 59 who had had hysterectomies — Dr. Philip Sarrel and colleagues calculated that rejecting estrogen-only hormone therapy resulted in the early deaths of nearly 50,000 women between 2002 and 2011.


“What has happened is an avoidance of use of estrogen not because of the [study] findings, but because of the way they were communicated and understood,” Sarrel said, in a video interview released Thursday by Yale. “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, he added.

Using mortality rate data to calculate the number of women who died, the team’s analysis estimated that between 40,292 and 48,835 women died prematurely during the study period.

Prior to 2002, the team wrote, 90% of women who had had hysterectomies would have used estrogen therapy for around five years. Today fewer than a third do — even though ongoing studies by the Women’s Health Initiative in 2004 and 2011 had showed that women who had had their uteruses removed and who took estrogen alone actually had a decreased risk of early death, compared to women taking a placebo (mostly, because of reduced incidence of heart disease.)

The coauthors urged researchers, healthcare providers and the media to devote a special effort to making sure patients understood the potential benefits of estrogen-only hormone replacement therapy in women who do not have a uterus.

“Distortion of details can prove to be nothing less than lethal,” they wrote. “The Women’s Health Initiative findings need to be presented so that the very important differences between the two treatment modalities are emphasized and the benefits for hysterectomized women aged 50 to 59 years are appreciated. This effort has clearly been inadequate to date.”

[UPDATED July 18, 3:59 p.m.: Dr. Rowan Chlebowski, an investigator at the Los Angeles Biomedical Research Institute, sounded a note of caution. “This paper does not present any new clinical trial results,” he wrote in an email. “Rather it is an analysis based on aggressive assumptions.”


Chlebowski said that while the analysis might “support new hypotheses ... they do not provide reliable evidence to inform clinical practice or to make reliable claims about mortality consequences.”]

Read a summary of the American Journal of Public Health study here.

Read a Yale press release detailing the study findings.

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