Combined HRT cannot save itself.

Combined estrogen and progestin hormone therapy has reached new levels of controversy in recent months. The health benefits do not appear to be worth the risks.

In May, two studies in JAMA reported the results of a four-year study of 4,532 women among 39 different medical centers. The women (age 65+) who took a widely-prescribed combination of estrogen and progestin developed Alzheimer's at twice the rate of the same-aged placebo group (there were 40 cases total vs. 21 among the controls).

While the number is not large, it certainly gives pause to many doctors and their patients who wonder if the risk is worth it. The evidence against this form of HRT does not stop there, however. It now appears that in addition to stimulating breast cancer growth, combined HRT makes tumors harder to detect. Early detection is a vital weapon in the battle against cancer.

Among the 8,506 HRT subjects studied, 245 total cases were discovered vs. 185 among the 8, 102 placebos. 25.4% of the women using HRT had invasive breast cancers, vs. 16% in the placebo group. All subjects had yearly mammegrams. The cancers detected among the HRT subjects were larger, more advanced in nature and difficult to treat.

Used by postmenopausal women to reverse the onset of osteoporosis and for treatment of severe hot flashes and night sweats, combined estrogen and progestin therapy is an option the medical community seems on the verge of retiring. There are other documented risks in addition to these new findings, including an increased risk of myocardial infarction and of stroke. Women who take estrogen alone are being studied separately.

(JAMA, 2003, Vol. 289, No. 24, pp. 3243-3253, 3254-3263)