For decades women have been encouraged to use hormone replacement therapy to stave off a variety of ills—from menopausal symptoms such as hot flashes and night sweats to heart disease and osteoporosis. But as the result of new research over the past few years, more experts are urging caution. Recent findings suggest that women taking hormone therapy have slightly more heart attacks, strokes, blood clots, and breast cancer than those who do not. Now researchers are trying to understand how a woman’s individual characteristics might increase or lower her risks for these problems. This Newsweek story focuses on a minor component of a larger analysis about the potential influence of age and years since menopause on the risk of cardiovascular disease. The story says that certain older women are at increased risk of heart disease and heart attacks if they had lots of hot flashes and take hormone therapy. It quotes the study’s author saying this means that older women with these symptoms “should try to get off hormone therapy” and receive treatment for heart disease risks. Alerting readers to the potential significance of hot flashes and night sweats is alright—but only if it is accompanied by the clear message that the line connecting hot flashes and hormone therapy to heart attacks and death is convoluted and unclear. The “danger” is not statistically significant, remains hypothetical, and requires further research. The phrases “possibly” and “could be” don’t capture the provisional quality of the new findings.
Readers will also appreciate hormone therapy’s risks better if they know their frequency. Exactly how many more women taking hormone therapy have problems than women taking no therapy? (Or, in researchers’ terms, what’s the absolute excess risk?) The published study included data on the risk of nonfatal heart attacks and death as well as stroke for women who took hormone therapy closer to menopause and others who took it more distant from menopause. For example, in a group of 10,000 women within 10 years of menopause, 6 fewer women had a heart attack or died while taking hormone therapy than while taking placebo, but 8 more had strokes. In a group of 10,000 who passed through menopause 20 years ago or more, 17 more women had a heart attack or died while taking hormone therapy than while taking placebo and 13 more had strokes. Some readers with bad hot flashes and night sweats might think these numbers are worth worrying about, and some might not. If readers had heard from an expert who was not a member of the research team, they might have been alerted to the shaky foundation of the “hot flash” findings and heard a less worrisome message. Accurately conveying the nuances of risks, benefits, and cost is the key to helping individual women make informed decisions. It should be noted that this story is accompanied by an extensive web-only feature with much more discussion. But readers of the print magazine version would not necessarily see this.
The article does not mention the cost of hormone therapy or compare its cost against that of other therapies. Since the story suggests that treatment might be helpful in younger women with severe hot flashes, cost is relevant.
The article suggests that hormone therapy might help younger women control hot flashes. But the primary subject of both the Newsweek story and the new research is harms of therapy, not benefits, so we consider this criterion not applicable in this case.
The Newsweek story summarizes the previously published analyses of the Women’s Health Initiative trials, which found that women who received hormone therapy had a slightly higher risk of heart attacks, strokes, blood clots, and breast cancer than women who received placebo. It reports new data on the harms of hormone therapy in women who have hot flashes and night sweats. However, the story does not report the frequency of these potential harms, making it difficult for readers to judge their risks. Some readers with bad hot flashes and night sweats might think the risks of heart attack and death are too small to worry about, others might not. (See “Comments” below.)
The article fails to alert the reader to the provisional quality of the new findings. As the researchers note in their published manuscript, the current subgroup and secondary analyses are “exploratory” and “not statistically significant.” In other words, they represent very interesting hypotheses for further exploration. The also demonstrate how little we know about menopausal symptoms and their management. The news story says only that the analyses “had some technical issues.”
According to the story, hot flashes might be “dangerous” because they might predict heart disease. Thus, the article adds another normal feature of aging (postmenopausal hot flashes) to the list of experiences that are not only distressing and uncomfortable but also apparently perilous to a woman’s health. Unfortunately, the article fails to note that none of the research findings are statistically significant. Hot flashes might be important, or they might not.
The article cites the lead author of the new study, who is also the head of the Women’s Health Initiative. But a second source not associated with the research might have added a valuable and different perspective, perhaps pointing out that the evidence is weak and does not warrant action by women or their health care providers.
The story mentions one option to hormone therapy for managing difficult symptoms of menopause—doing nothing. The current evidence suggests there are few other good options. But there are several strategies for preventing and treating heart disease and stroke, including exercise and diet, as well as monitoring risk factors such as high blood pressure and cholesterol.
The story does not mention availability, but most readers affected by hot flashes will be familiar with hormone therapy.
The article accurately suggests that hormone therapy is not a new treatment.
The story did not appear to rely solely or largely on a news release.