Hormone Replacement in the Menopausal Woman

Over the past several years, there have been repeated headlines surrounding the evidence obtained from the Women's Health Initiative (WHI). The WHI is a large federally funded study examining the effects of hormone replacement therapy in menopausal women on the primary prevention of cardiovascular disease and osteoporosis.

The first portion of this study involved 16,608 healthy menopausal women. Women taking a combination of estrogen and progesterone were compared to a placebo group. Data from this study was reviewed after 5.2 years. Based on those findings, it was determined that the risks outweighed the benefits for the group on estrogen and progesterone and, therefore, this portion of the study was discontinued early in 2002. Evidence showed a small increase in heart attack, stroke, blood clots, and breast cancer in the women taking hormones. It also showed a decrease in hip fractures and colon cancer in this group. Results of this are summarized below.

Estrogen/Progesterone        Placebo
(events per 10,000 women per year)
_____________________________________________

Heart Attack                             37                                 30

Stroke                                     29                                 21

Blood Clots                               34                                 16

Breast Cancer                            38                                 30

Hip Fracture                              10                                 15

Colorectal Cancer                       10                                 16

The second portion of the WHI involved 11,000 healthy menopausal women who were taking estrogen versus a placebo group.  This portion of the study continued for two additional years, but was also halted early in 2004 after review of the evidence.  This portion of the study found an increased risk of stroke and blood clots in the group of women taking estrogen.  It also showed a decreased risk of hip fracture.   Finally, the study showed no statistically significant difference in the risk of breast cancer, heart attack, or colon cancer compared to placebo.  Results are summarized below.

Estrogen                         Placebo
(events per 10,000 women per year)
_____________________________________________

Heart Attack                             54                                 39

Stroke                                     44                                 32

Blood Clots                               21                                 15

Hip Fracture                              11                                 17

Breast Cancer                            26                                 33

Colorectal Cancer                       17                                 16

We understand that these findings can be very confusing and make the decision about hormone replacement an ongoing controversy.  Deciding whether to continue or start hormone replacement therapy is a very individualized decision.  Discussing your symptoms and thoroughly reviewing your personal and family medical history with your doctor is the first step.  Some of these symptoms may include hotflashes, vaginal dryness, or a new finding of osteoporosis.  Hormone replacement is one option of treatment but there are also alternative treatments that may be right for your situation.  Our group is dedicated to helping you find the best solution.