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Saturday, May 25, 2013
Hormone Replacement Therapy has entered the healthcare spotlight recently when the WHI (Women's Health Initiative) study stopped the hormones on one arm of its study earlier than expected. Many women have questions regarding this topic. Margery Gass, M.D., Professor in the Department of Obstetrics and Gynecology at the University Of Cincinnati College Of Medicine and principal investigator at the Cincinnati site of the WHI, has provided brief answers to several questions that are of interest on this topic on this topic:
The WHI is a 15 year nation-wide study designed to answer whether hormone replacement therapy (HRT) would be beneficial overall as a preventive health care measure for the majority of postmenopausal women. The hormone therapy arm of the study is divided into two groups, one group taking combined estrogen and progestin, the second group taking estrogen only. The latter group is comprised only of women who have had a hysterectomy, and that arm of the hormone study is still ongoing.
A second arm of the study is following risks and benefits of a low fat diet, and a third arm of the WHI is looking at risks and benefits of calcium/vitamin D supplementation. Over 161,000 healthy postmenopausal women are participating in this study, including over 3,000 in the Cincinnati area These volunteers are making a major contribution to women's health!
Researchers stopped the estrogen and progestin hormone therapy after 5 years because the therapy's risk was determined to be greater than the benefit. Taking HRT did not prevent heart disease as was hoped, and, in fact, it increased the risk of heart attacks, strokes, blood clots, and invasive breast cancer. Researchers did find some benefits for those taking HRT, including a lower incidence of colorectal cancer, osteoporosis and hip fractures. These two benefits did not outweigh the risks by statistical analysis.
This study looked at the effects of only one particular estrogen plus progestin pill, known as Prempro. It did not look at other types of estrogen or progestin nor did it look at other doses. Thus, it cannot be said the results of the WHI study of combined estrogen and progestin can be generalized to all types of HRT. However, neither can one assume that other types of HRT are necessarily safer. There are many different types, doses, and means of taking HRT. Further studies need to be done to determine if other types and methods of therapy are indeed safer.
Women take the combined estrogen and progestin for a variety of reasons including menopausal symptoms, such as hot flashes and sleep disturbances. For the short-term use, the benefits may outweigh the risks. It is important for women to talk with their health care provider about their own personal risks and benefits. Other methods of prevention, such as nutrition, exercise and other lifestyle changes should be discussed.
In summary, if you are on combined estrogen and progestin, you should reconsider why you are taking HRT and what you hope to gain from it. Then review the risks and benefits reported by the WHI with your clinician to determine if HRT is in your best interest For further information on this topic visit the Women's Health Initiative homepage or visit the NetWellness Ask an Expert topic areas Menopause or Osteoporosis.
Last Reviewed: Aug 01, 2002
Margery Gass, MD
Formely, Professor, Clinical Obstetrics & Gynecology
College of Medicine
University of Cincinnati