title: The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years.
abstract: OBJECTIVE
  We examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years.
  
  
  METHODS
  We derived a formula to relate the excess mortality among hysterectomized women aged 50 to 59 years assigned to placebo in the Women's Health Initiative randomized controlled trial to the entire population of comparable women in the United States, incorporating the decline in estrogen use observed between 2002 and 2011.
  
  
  RESULTS
  Over a 10-year span, starting in 2002, a minimum of 18 601 and as many as 91 610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET).
  
  
  CONCLUSIONS
  ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall. Our data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years. Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency.
authors.affiliation: Departments of Obstetrics and Gynecology and Psychiatry, Yale University School of Medicine, New Haven, CT, USA. philip.sarrel@yale.edu
authors.forename: Philip M
authors.initials: PM
authors.lastname: Sarrel
authors.forename: Valentine Y
authors.initials: VY
authors.lastname: Njike
authors.forename: Valentina
authors.initials: V
authors.lastname: Vinante
authors.forename: David L
authors.initials: DL
authors.lastname: Katz
mesh_terms: D004967:Estrogens / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000401:mortality*; D008875:Middle Aged; D010052:Ovariectomy / Q000401:mortality; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology
chemical_list: D004967:Estrogens