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Safety-related Opposition or Misjudgment?
Two decades ago, the use of hormone replacement therapy (HRT) to treat hormone deficiency was met with widespread opposition due to a pivotal study in 2002.
This study, the Women’s Health Initiative (WHI), significantly impacted people’s perception of HRT. It claimed that over 16,000 women (aged 50 to 79 years) who took a combination of estrogen and progestin (E+P; 0.625 mg/d) from 1993 to 1998 had a heightened risk of various health complications after over 5 years of follow-up, including:
- Breast cancer: 290 cases
- Coronary heart disease (CHD): 286 cases
- Stroke: 212 cases
- Colorectal cancer: 112 cases
- Hip fracture: 106 cases
- Endometrial cancer: 47 cases
This alarming finding sent shockwaves throughout the medical community and the general public, leading to a drastic decline in the use of HRT in the United States.
The revelation of increased risks associated with the E+P combination caused a substantial shift in public opinion and fueled concerns about the safety of HRT. As a result, many women already undergoing or considering hormone therapy became hesitant, and healthcare providers began to exercise caution when prescribing these treatments.
The repercussions of the study were profound, with hormone therapy plummeting by approximately 80% in the United States alone.
Current Findings: Benefits Outweigh Risks
However, subsequent research and reevaluation of the WHI study from 2002 to 2006 have provided a more nuanced understanding of the risks and benefits of HRT.
For example, in the years following the initial study, additional evidence emerged, suggesting that the risks associated with HRT might be influenced by factors such as the patient’s age, the timing of hormone initiation, and the patient’s underlying condition.
Typically, the starting age for HRT is around the time of menopause, usually at 51 years of age. However, it is generally recommended that hormone initiation occurs within 10 years of menopause onset to maximize potential benefits and minimize risks.
However, the decision to undergo HRT should be based on an individual’s unique circumstances, and healthcare providers should consider the underlying health conditions. For example, women with a history of breast cancer, liver disease, blood clots, or certain cardiovascular conditions may require additional considerations before starting HRT.
For this reason, medical guidelines and recommendations have evolved, aiming to tailor hormone therapy decisions to individual patient characteristics and needs.
The latest and most comprehensive direction for proper utilization of HRT may be the position statement made by the North American Menopause Society (NAMS).
This publication gathered information from various studies on HRT. It concluded that the benefits of HRT for treating and managing menopause symptoms significantly outweigh the potential risks that only occur to a minimal extent during the treatment.
The 2017 Women’s Health Initiative Trials
Recognizing the positively changing situation surrounding people’s perceptions and healthcare providers’ practice made on HRT, the Women’s Health Initiative decided to implement another long-term study in 2017. It aimed to finalize our understanding of the relationship between the therapy and the potential risks.
The study followed a total of over 27,000 women (aged 50 to 79 years) who were assigned to either conjugated equine estrogens plus medroxyprogesterone acetate (CEE + MPA; 0.625 mg/d + 2.5 mg/d), CEE alone, or a placebo for a mean of 5.6 and 7.2 years.
After 18 years of follow-up, the 2017 WHI study found that the all-cause mortality rate was 27.1% in the HRT group and 27.6% in the placebo group.
This number means that compared to a placebo, hormone therapy with CEE + MPA or with CEE alone was not associated with a risk of all-cause mortality. This finding has further reinforced our belief that HRT can significantly benefit women in treating and managing their menopause symptoms while not posing life-threatening risks in the long term.
Even though HRT can increase the risk of certain cancers and other conditions, the safety threshold has been determined. The CEE + MPA combination (for women without hysterectomy) must discontinue after 5.6 years, while the duration for CEE treatment alone (for women with hysterectomy) is 7.2 years.
You can also read the complete research here.
Thank you!
Larry Siegel, NP
Founder/CEO @ Yunique Medical
