Menopause hormones appear to reduce risk of diabetes

By TARA PARKER-POPE
HEALTH MATTERS; WSJ.com

For years, doctors have talked about the health effects of hormones on bones, breasts and women's hearts. But one of the biggest concerns of aging -- diabetes -- hasn't been part of the debate.

Until now. Last week, the North American Menopause Society updated its recommendations for women considering menopause hormones. For the first time, the group noted that diabetes risk appears to be lower in women who use hormones. The group said there isn't enough evidence to suggest that women start taking hormones to prevent diabetes, but the chance of lowering diabetes risk should be reassuring to women who are considering hormones to cope with hot flashes and other symptoms of menopause

THE JOURNAL REPORT

"We've not addressed diabetes in the past," says Wulf Utian, executive director of the North American Menopause Society, one of the leading medical organizations to advise women on midlife issues. "But there now are a number of studies suggesting that estrogens are having a beneficial effect on sugar metabolism. This is an area that we feel is extremely important."

Why diabetes risk has been ignored in the hormone debate isn't clear. As a health issue, diabetes is clearly as important as cardiovascular disease, breast cancer and stroke, yet it doesn't resonate as much with the public. According to the World Health Organization, more than 3.2 million deaths each year are attributable to diabetes. By comparison, about 500,000 deaths world-wide are caused by breast cancer.

Cascade of Problems

Diabetes itself often doesn't kill you, but it can lead to other deadly problems. The leading cause of death among people with diabetes is heart attack and stroke, and about 40% of all heart attacks are caused by diabetes. Diabetes is also the leading cause of blindness, kidney failure, impotence and amputations. It even shortens life expectancy by five to seven years.

According to the Centers for Disease Control and Prevention, seven out of every 1,000 women will be diagnosed with diabetes. And the risk is growing. In 2004, the incidence of diabetes increased by 34% among people between the ages of 45 and 64, jumping to 11.4 cases per 1,000 people from 8.5 cases in 1997.

What's surprising is that a number of well-regarded studies show that hormone use dramatically lowers diabetes risk, but that fact is virtually ignored when experts talk about the risks and benefits of menopause hormones. In fact, the Women's Health Initiative, which was stopped early in 2002 because hormone use in older women was linked with a higher risk of heart attack, also showed that hormone use dramatically lowered the risk for diabetes.

According to the WHI, women who used estrogen and progestin were 21% less likely to develop diabetes, and women who used estrogen by itself were 12% less likely to develop the disease. That translates to about 15 fewer cases per 10,000 women each year. And the WHI isn't the only study to show the benefit. A major study called the Heart and Estrogen/Progestin Replacement Study showed that the combination of estrogen and progestin reduced the chance of developing diabetes by 35%.

"This is an important finding that tends to be overlooked in most reports about the benefits and risks of hormone therapy," says Harvard professor JoAnn Manson, a WHI investigator.

It's not clear exactly how hormones influence diabetes risk. Type 2 diabetes, the most common form, usually is triggered by a combination of obesity, poor diet, lack of exercise and genetics. In patients with Type 2 diabetes, the body becomes unable to effectively process insulin and can't make enough of the hormone to maintain normal blood-glucose levels. Insulin is important because it promotes the storage and use of all nutrients, including sugar. Once full-blown diabetes occurs, glucose is barricaded from cells and instead accumulates in the bloodstream. There it may trigger a process similar to rusting: The sugar begins to stick to things, damaging kidneys, blood vessels and nerves.

Menopause hormones may lower the chances of developing diabetes because they lower elevated insulin levels in the blood. In the WHI, using estrogen and progestin produced a small drop in blood sugar and insulin levels after one year in the study. And a higher proportion of WHI women taking hormones lost weight compared with those taking a placebo, so that may also have been a factor.

Something to Weigh

Despite these findings, many doctors agree that lowering diabetes risk isn't reason enough to take hormones. They still recommend that menopause hormones should be prescribed only for women suffering from hot flashes, sleep problems and other symptoms of menopause. However, for a woman with a strong family history of diabetes, the WHI and other data looking at diabetes risk should be factored into her personal hormone decision, along with all the other health issues associated with hormones, including a slightly higher risk for breast cancer, stroke and blood clots, as well as a lower risk for colon cancer and uterine cancer.

Some data suggest that younger women who take hormones to treat symptoms may gain some heart protection, while starting hormones long past menopause dramatically increases heart risk in older women.

"The evidence with regard to diabetes is just beginning," says Dr. Utian. "We didn't see this as a sole indication for prevention of diabetes, but we do see it as a potential benefit of hormones."

Source:
http://online.wsj.com/article/SB117028329915394231.html
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