Neurology: Enzyme Linked to Pathology of Parkinson's Disease Appears Two-faced Hematology: New Device Documents Clot Formation in Living Mice Women's Health: Conference Updates Hormone Replacement Therapy Medical Education: First Medical Education Day Held at HMS   Disease-related Protein Domain Steers Cell Fate High-intensity Exercise Reduces Heart Risk Gene Identified for Severe Nervous System Disorder   HMS and HSPH Faculty Elected to the Institute of Medicine HMS Publications Issues Guide to Men's Health Science Seminars Extend Reach into Community Method for Choosing Statistical Models Shown World AIDS Day Concert to be Presented at Harvard Woodruff Named HSPH Resource Development Dean Zoll Portrait Unveiled HMS/HSDM Faculty Survey Is Coming Conference Explores the University's Digital Identity Honors and Advances News Briefs   Series on Medical Mistakes Targets Preclinical Students   Front Page

WOMEN'S HEALTH Conference Updates Hormone Replacement Therapy The recent findings that hormone replacement therapy (HRT) may cause more long-term health risks than benefits left many women who were taking the medication confused and unsure of what to do. It also left clinicians grappling with the new findings in an attempt to help patients decide whether to change their treatment. Attendees of the Women's Health Research Conference on Oct. 9 heard the rationale behind the new recommendations and how they affect patients and physicians. Kathryn Martin (right) answered questions from clinicians about hormone replacement therapy options during a panel discussion moderated by Hadine Jaffe (left). (Photo by Steve Gilbert) "How did we get to this point?" asked JoAnn Manson, HMS professor of medicine and chief of preventive medicine at Brigham and Women's Hospital, citing the 20 million women in the U.S. alone on HRT. The history of HRT's popularity, she explained, goes back to the 1960s when the book Feminine Forever touted the ability of estrogen therapy to keep women attractive, youthful looking, and "more pleasant," by holding the signs and symptoms of menopause at bay. Although researchers have long looked for more tangible health benefits of taking estrogen, the first clinical trial of estrogen and coronary heart disease, ironically, was conducted in men 30 years ago and was stopped early because estrogen raised their risk of having cardiac events. Rather than conducting a trial in women at the time, Manson said, "it was just assumed that there would be protection of women's hearts by HRT and an overall favorable benefit-to-risk ratio." Despite findings suggesting estrogen could raise the risk of endometrial cancer, sales continued to increase when progestins were added to counteract the risk. Studies suggested that HRT could help ward off osteoporosis, which bolstered the case that hormones could prevent disease rather than just treat symptoms. And observational studies strongly suggested that these hormones could prevent heart disease in women, which was "without question a beautiful hypothesis," Manson said. But "as facts began to emerge from randomized clinical trials ... this hypothesis was no longer standing up." The Women's Health Initiative trial found that HRT raised the risk of heart disease, stroke, pulmonary embolism, and invasive breast cancer, while lowering the risk of colorectal cancer and hip fractures--overall unfavorable odds. While the excess risk for each woman is quite small, it adds up to tens of thousands of additional health problems nationwide. Kathryn Martin, HMS assistant professor of medicine at Massachusetts General Hospital, then spoke about the question now facing clinicians: how do we deal with the new data? Martin said that physicians should be prescribing HRT for short-term relief of symptoms of menopause like hot flashes and genitourinary atrophy--for which estrogen is still the gold standard treatment. For women who want an alternative or are at a high risk for conditions that HRT might exacerbate, Martin said that she sometimes prescribes medications such as vaginal estrogen or antidepressants for hot flashes. In light of recent findings, she said, long-term use of HRT is not recommended, but occasionally patients choose to continue taking it for quality-of-life reasons. Martin noted that the question of whether estrogen protects against dementia and cognitive decline, as has been suggested by some researchers, is still unanswered and could throw off the current balance of benefits and risks if it does. The conference, held at the Longwood Galleria, was sponsored by the HMS Center of Excellence in Women's Health and featured talks on current issues in women's health and a poster session on research in basic and clinical science, health services, and education funded by the center. --Courtney Humphries