Recommendations for hormone replacement therapy (HRT) have come a long way since the abrupt end of the Women s Health Initiative (WHI) trial in 2002. Following the trial, HRT use steeply declined, as both women and their doctors became reluctant to use this therapy.
Although it has been determined over the last decade that the problems that ended the WHI were primarily occurring among older women who started HRT long after menopause and continued using it for many years, it took some time for the scientific community to reassess the treatment. Even Dr. JoAnn Manson, professor at Harvard Medical School and leader of the WHI research, said the decline might have been 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.
Nevertheless, for post-menopausal women HRT may not be beneficial when prescribed to prevent chronic diseases, such as heart disease and age-related dementia. The United States Preventive Services Task Force published a recommendation in the Annals of Internal Medicine against the use of estrogen and progestin for the prevention of chronic medical conditions in postmenopausal women and against the use of estrogen alone for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. The new recommendation, which matches the task force s 2005 recommendation, was made following a review of 51 articles published since 2002.
It is now a general consensus among most academic and medical societies in contrast to what clinicians believed before the WHI study that HRT should not be used to protect against chronic diseases, says ACSH s Dr. Gilbert Ross. However, there is solid data, which the task force acknowledges, that HRT reduces the risk for fractures and increases bone density in post-menopausal women. Thus, the use of HRT should become an individual s decision in consultation with her doctor, he concludes.