Re-evaluating HRT safety and efficacy

Related articles

In 2002, a large study called the Women s Health Initiative (WHI) was abruptly halted after preliminary results showed that estrogen replacement therapy was associated with an increased risk of breast cancer and cardiovascular effects. Though it was later determined that these problems were primarily occurring among older women who started hormone replacement therapy (HRT) long after menopause, the damage had already been done. And according to the results of a new study published in Obstetrics & Gynecology, the number of women who take hormones continues to decline.

Dr. Brian Sprague, lead author and professor at the University of Vermont evaluated survey responses from over 10,000 women. Dr. Sprague and his colleagues found that, in 2009 and 2010, less than 5 percent of postmenopausal women over age 40 used either estrogen replacement therapy alone or a combination of estrogen and progestin. That s down dramatically from the 22 percent seen in 1999 and 2000.

But this drastic decline in HRT use is leading some doctors and researchers to reconsider their advice. For instance, in February of this year, the North American Menopause Society adopted a more flexible approach to HRT, one that takes into account the type and timing of therapy, as well as individual patient history.

Dr. JoAnn Manson, professor at Harvard Medical School and leader of the WHI research, said the decline might be an overreaction. "The pendulum may have swung too far in the direction away from hormone therapy use," she stated. In a younger woman who has hot flashes, night sweats, and impaired quality of life, it is very likely that the benefits of short term hormone therapy will outweigh the risks.

ACSH's Dr. Ruth Kava agrees, noting, It s important that interpretation of scientific studies not be exaggerated. In the case of HRT, many women were denied a useful and safe treatment for menopause-associated discomfort.