In 1991 NIH launched the Women’s Health Initiative (WHI Study), clinical trials designed to test the effect of postmenopausal hormone therapy, diet, calcium and vit-D on risk of heart disease, bone fractures, stroke, breast and colorectal cancer.
Subjects: 161,808 “healthy” postmenopausal women aged 50-79, average age 63.
Three Arms of the WHI STUDY:
- Estrogen Alone (Premarin) E
- Estrogen + Provera ( medhydroxy-progesterone) E+P
In 2002 INITIAL RESULTS of WHI Study were released and reported worldwide:
E+P Arm: Slight increased risk of heart disease, stroke, blood clots, and breast cancer
E alone Arm: slight increased risk of stroke and blood clots; no benefit on heart attacks and slight decreased risk of breast and colon cancer and osteoporosis
Uncertainty caused physicians to stop prescribing hormones.
Result (in the U.S): Rx’s decreased from 61 million in 2001 to 21 million in 2004. In addition to 40 million women who went off their HRT, there is an additional generation of women from 2002 to current date who have purposely avoided or been denied hormone replacement therapy.
WHAT DO WE KNOW NOW?
July 2017: NAMS (North America Menopause Society) published their 2017 UPDATED Position Statement on HRT:
- Authors stated their prior 2012 Position Statement on HRT is “NOT valid”
- Authors further state: the prior concept of the lowest dose HRT for the shortest period of time was inadequate or even harmful for some women”
- “…the use of hormone replacement therapy for menopausal and postmenopausal women … guarantees to make healthcare providers and the women they treat more comfortable using HRT, when women want it to improve their quality of life”.
JoAnn Pinkerton, MD, Executive Director of NAMS, July 2017 – Volume 24, Issue 7, p728-753
September 2017: Original authors of the WHI Study published their 18-year follow -up results in Journal of the American Medical Association (JAMA):
Estrogen alone or estrogen + progesterone combination was NOT associated with an increase in all-cause mortality OR cause -specific mortality, including cardiovascular disease mortality, cancer mortality and other major causes of mortality after 18 years of follow-up! Menopause Hormone Therapy and Long-Term All-Cause and Cause-Specific Mortality – The Women’s Health Initiative Randomized Trials Mortality Risk. JAMA Sept.12,2017; 318:927-938.
WHAT ARE THE BENEFITS OF HRT IN WOMEN?
Relief of symptoms: vasomotor, sleep disturbance, anxiety/ depressive symptoms, cognition and memory, atrophic genital changes, lower urinary tract ( UTI, urinary incontinence, overactive bladder)
Long-Term Benefit vs Risk of HRT:
- Cardiovascular Disease: ↓ 50% heart attack; stroke neutral
- Reduced risk of Type 2 diabetes
- Improved bone mineral density and fracture risk
- Reduced risk of dementia and Alzheimer’s
- Breast Cancer – WHI: neutral to ↓21-40% with ERT; slight ↑ with Provera
- Colorectal Cancer – WHI: slightly ↓
- Endometrial Cancer – Preventable w/progesterone
- Ovarian Cancer – WHI: neutral or slight ↓
- 30-60% reduced all cause mortality
Long term benefits exceeds any alleged risks; especially when initiated within 10 years of menopause.