Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (1)

Hormone Replacement Therapy: What We’ve Learned From The Women’s Health Initiative

This is the study that doesn’t end…
The longterm follow up extends…
Some people started studying hormones in menopause,
And they’ll continue publishing more data just because…
(repeat)

In yet another paper in a major journal, we hear once more from the investigators of the Women’s Health Initiative. This time it’s the long term outcomes of women who took estrogen alone, now seven years out from stopping their hormones. What new information can we learn from this extensive analysis of new data?

Nothing.

Really.

The WHI’s been telling us the same thing about ERT (Estrogen replacement therapy) and HRT (Combination estrogen/progestin therapy)  since 2002, and all each subsequent study does is reinforce and expand on that initial data. Unfortunately, it will probably take a few more papers before some folks accept the results of this important study, which, though flawed, continues to inform the practice of menopausal medicine.

Allow me to summarize what we know  -

  • HRT/ERT does not prevent heart disease when given to women of average age 64 years, or 10 years past menopause.
  • HRT/ERT increases the risks of stroke and blood clots, a risks that trends upward with age. Once you stop HRT/ERT, these risks go away.
  • HRT/ERT protects against osteroporosis, a benefits that goes away once you stop taking it.
  • In younger women, particularly those who have just become menopausal, HRT/ERT may reduce heart disease risks. (The operational word here is may…)
  • HRT increases the risk of breast cancer, on the order of about 1% if you use it for 20 yrs. This risk has been shown in almost every study of HRT ever done, is biologically plausible and supported by the fact that drugs that block estrogen have been shown to prevent and treat breast cancer.
  • ERT, when taken alone by women 10 or more years post menopausal, may actually slightly lower breast cancer risks. We think this is because of the way estrogen acts when it is reintroduced after a long absence. Unfortunately, since this is not the way we prescribe estrogen (ie, starting it 10 years after menopause), this benefit is if no use to anyone. So let’s stop talking about it already.

On balance, there is no compelling preventive health reason for most women to take HRT, and women who take it live no longer than those who don’t.

That said, some women may choose to use HRT to treat menopausal symptom or osteoporosis, conditions for which it is quite effective. But if you use HRT, you must accept a small but real risk of blood clots, stroke and breast cancer. (Although taking low doses through the skin may lower the clot risk.) These risks apply whether the estrogen you take is from pregnant mare’s urine, a plant or the moon, whether it is bio-identical or whether Suzanne and Oprah are taking it.

If you’re in early menopause and thinking that taking HRT will be good for your heart or brain, you can think it if you want, but I would not take it for these reasons alone. Stick to other proven methods for lowering your heart disease risks – maintain a healthy diet and body weight, exercise, quit smoking and treat high blood pressure or elevated cholesterol that does not respond to these interventions.

Once again, here are my rules for prescribing HRT.

*This blog post was originally published at The Blog That Ate Manhattan*


You may also like these posts

Read comments »


One Response to “Hormone Replacement Therapy: What We’ve Learned From The Women’s Health Initiative”

  1. Kris says:

    I am a Natural Hormone Replacement Therapy patient of EquilifeMD.com and it is a great alternative with there Equip Hormone Therapy as opposed to a synthetic product.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »