Hormone Replacement Therapy
The Women's Health Initiative Study
The media has publicized findings from the Women's Health Initiative
(WHI) report, which was published in the Journal of the American Medical
Association. The report indicated an increased risk of heart attacks,
strokes and breast cancer in women using some forms of hormone replacement
therapy during menopause. In addition to the clinical implications for
a woman using hormone replacement therapy, these findings and recommendations
also bring about significant emotional issues. Ultimately, it is the decision
of each patient to decide whether hormone replacement therapy is appropriate
for her needs. Our job as practitioners is to provide counsel and assistance
in helping women come to decisions with which they are comfortable.
The WHI study helped investigators better determine some of the potential
benefits and risks associated with the use of hormone replacement therapy.
The study measured a number of questions including the risks of heart
disease, breast cancer, colorectal cancer, fractures and stroke. The groups
studied included two hormone-replacement regimens. One regimen involved
use of two hormones -- an estrogen and a progestin, and was given to women
who had not had a hysterectomy. The second regimen was estrogen only,
and was given to women who have had a hysterectomy. Estrogen alone is
not usually given to women who still have their uterus, except in very
low doses, because it can be associated with an increased risk of cancer
of the lining of the uterus. The portion of the study using a combination
of an estrogen and progestin has been discontinued. The portion of the
study using estrogen alone has not been associated with the same risks,
and continues.
The study is one of hundreds performed over the last 40 years to evaluate
hormone use. Although it is one of the newest studies, and one of the
better studies, it is neither the first nor last. There is both agreement
and contradiction with other good studies. Time has clearly demonstrated
the benefit of various hormonal regimens for successful treatment of menopausal
symptoms. These symptoms include, but are not limited to hot flushes,
vaginal dryness, urinary frequency and sense of well-being. While this
study suggests an increased frequency of breast cancer with hormone replacement,
other studies suggest that even though the risk of breast cancer itself
may be increased, the risk of death from breast cancer for those using
hormone replacement is less. This may relate to decreased aggressiveness
of the tumors noted and/or increased use of mammograms and examinations
to watch for early evidence of the cancer. The information from the WHI
study serves as a reminder that each woman is unique, and needs to have
a plan appropriate for her individual needs and circumstances. This can
best be handled by continuing to have timely visits with your health care
provider. Together, you can best determine measures to reduce risks of
health problems in the future (osteoporosis, cancer, heart disease), as
well as address quality of life issues for the present (menopausal symptoms).
Hormone replacement therapy, in one form or another, continues to be a
very viable alternative for many women seeking help with short- or long-term
health concerns. For other women, other options are available. Your decision
about use of medicines related to menopause, whether they be hormone replacements
or other medicines for osteoporosis, or menopausal symptoms, should viewed
as only a small part of your overall health picture. Mammograms, pap smears,
bone density studies and other health screenings continue to be important,
regardless of whether hormone medicines are used or not. These studies
are only part of a health care plan that includes diet and exercise, weight
control and smoking cessation.
We look forward to the opportunity to discuss these with you.