Stopping Hormone Therapy Linked to Cardiovascular Death

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Okay, this is big. This is the biggest news in hrt/menopause since the WHI cancellation. And, as the news article notes, it's gonna be controversial and an uphill battle, but so far the results look really really impressivee. Short form (quotes taken from the Medscape article linked above):
In the first year after a postmenopausal women discontinues hormone therapy, her risk for cardiovascular mortality is higher than if she had continued the therapy.
Or to put it in more quantitative terms:
In the first post-treatment year the discontinuation of HT use was accompanied with 26%– 66% elevations in the risk for cardiac or stroke death. This risk elevation was markedly higher in women who were younger than 60 years at the initiation or discontinuation of HT use.
So much for quitting hrt to a timeline. We already have data that the post-WHI hrt-cutting cost the world economy billions of dollars in lost productivity, that being a more important (*sigh*) measure to many than the level of misery experienced by those women, which was astronomical. Since that study cancellation the major medical consensus guidelines have been backing away from established timelines, defaulting to a woman's own evaluation of her needs while still emphasizing the risk-limiting "shortest possible time." Those guidelines have, however, escaped either the notice or the endorsement of many, many doctors, and the practice of time-based hrt prescribing continues on a very large scale.

But now we have a lot of pretty compelling data that arbitrary discontinuation of hrt to a schedule, absent other health considerations, is not just miserable but fatal. Oops.
In women 50 to 60 years of age, "we clearly see" that this "is doing more harm than benefit," he reported. "If women are otherwise healthy, they could continue hormone therapy as long as they wish."
Now this immediately raises two questions with respect to surgical menopause. First is of course the woman who is left post-op without hrt support, effectively the same thing as taking then stopping hrt when we're talking hormone levels. This makes "let's wait and see if you need it," a witless approach with surgical meno, not just cruel but potentially fatal. Let's take a moment and think about that. Yeah, not easy to come up with a lot of gratitude for that, is it?

We do have to raise the question: what about women with cancer risks or who have had cancer? And here it's obvious, really, that we need to individualize a great deal more than has been done with the current default policy: cancer of any kind = no hrt. That's going to be a challenge for women and their oncologists, and we probably can't expect that issue to be resolved in any useful way very soon. But that doesn't mean that women shouldn't ask and shouldn't press for a very clear evaluation of their relative risks beyond the kneejerk one that prevails right now.

The other issue is at the other end of the timeline. Does this mean that we need to continue hrt forever? That's not actually what this research is saying. The underlying action here likely will be seen not to be some magical property with which hrt is imbued but rather one of meeting current hormone needs. We've well established that our needs do decline with age, such that lower and lower doses of hrt make up coverage for that decreasing level of need. So there's no reason at this point to doubt that we can and should continue to step down, meeting our needs at their current level, until we are covering them on our own without an increment of supplementation. There's nothing to indicate that easing off of hrt in this fashion would present the same problems as discontinuing hrt when it was still needed, although that may change as this continues to be researched.

We've linked above to the full journal article, which can be downloaded in pdf format and also be found in our bookmarks account. It has some good examinations of the solid and the more questionable aspects of the study, which will come into play in the quibbling over it that has undoubtedly already begun. This is going to complicate the practice of prescribing hrt for doctors, but in a manner that brings it in a direction that women have always espoused: normalizing health rather than treating menopause like a disease, like something that only involves fertility. And that's good news for us.