The Women's Health Initiative Study

In early July, numerous newspapers, and broadcast media publicized findings from the Women's Health Initiative (WHI) report to be published in the Journal of the American Medical Association of an increased risk of heart attacks, strokes, and breast cancer in women using some forms of Hormone Replacement Therapy (HRT) with menopause. In addition to the clinical implications for a woman using Hormone Replacement Therapy, these findings and recommendations also bring about significant emotional issues. Ultimately, it is the decision of each patient to decide whether Hormone Replacement Therapy is an appropriate choice for their individual needs. Our job as practitioners is to provide counsel, and assistance in helping you to come to a decision with which you are comfortable.

The WHI study was developed and designed to help investigators better determine some of the potential benefits and risks associated with the use of Hormone Replacement Therapy. The study was designed to measure a number of questions including the risks of heart disease, breast cancer, colorectal cancer, fractures, and stroke. The groups studied included two Hormone Replacement regimens. One regimen involved use of two hormones--an estrogen and a progestin, and was given to women who had not had a hysterectomy. The second regimen was estrogen only, and was given to women who have had a hysterectomy. Estrogen alone is not usually given to women who still have their uterus (womb), except in very low doses, because it can be associated with an increased risk of cancer of the lining of the uterus. The portion of the study utilizing a combination of an estrogen and progestin has been discontinued. The findings that brought this about are given below. The portion of the study using estrogen alone has not been associated with the same risks, and continues. It is scheduled to be complete by March 2005. Review of the table below may help provide some perspective on the magnitude of changes noted, and some appreciation for the risks both when the medications in question are used, as well as when they are not.

The WHI study is one of literally hundreds of studies performed over the last 40 years to evaluate hormone use. While it is one of the newest studies, and one of the better studies, it is neither the first or last. There is both agreement and contradiction with other good studies. Time has clearly demonstrated the benefit of various hormonal regimens for successful treatment of menopausal symptoms. These symptoms include, but are not limited to hot flushes, vaginal dryness, urinary frequency, and sense of well-being. While this study suggests an increased frequency of breast cancer with hormone replacement, other studies suggest that even though the risk of breast cancer itself may be increased, the risk of death from breast cancer for those using hormone replacement is less. This may relate to decreased aggressiveness of the tumors noted and/or increased use of mammograms and exams to watch for early evidence of the cancer. The information from the WHI study serves as an additional reminder that each person is unique, and needs to have a plan appropriate for their individual needs and circumstances. This can best be handled by continuing to have timely visits with your healthcare provider. Together you can best determine measures to both reduce risks of health problems in the future (osteoporosis, cancer, heart disease), as well as address quality of life issues for the present (menopausal symptoms).

Hormone Replacement Therapy, in one form or another, continues to be a very viable alternative for many women seeking assistance with short or long term health concerns. For other women, other options are available if they choose to use them. Your decision about use of medications related to menopause, whether they be hormones, or other medications for osteoporosis, or menopausal symptoms, should be viewed as only a small part of your overall health picture. Mammograms, pap smears, bone density studies, and health screening studies continue to be important, as can be seen from the above table, regardless of whether hormone medications are used or not. These studies in turn are only a part of a health care plan that includes diet/exercise, weight control, and cessation of smoking.

We look forward to the opportunity to discuss these issues with you.