Hormone Replacement Study Findings Not Well Known

Most women are unaware of the results of a large-scale study that found significant cancer and heart risks associated with long-term hormone replacement therapy (HRT), says a report in the journal Menopause.

That study, called the Women's Health Initiative (WHI), generated massive amounts of publicity immediately after it was released in 2002. Its data caused many American women to abandon HRT altogether.

But just two years later, in June 2004, fewer than one third of women surveyed by Stanford University researchers said they knew about the findings.

"I was quite surprised by that," says study author Dr. Randall Stafford at Stanford University. "Other research had indicated that up to half had heard about it."

One-Third of Women Know of the WHI

When asked if they had talked about hormone therapy with their physicians, the researchers found that 36 percent of women aware of the WHI findings had talked about it with their physicians.

But only 15 percent of those who did not know about the study results did.

"We need to do a better job of disseminating information," says Dr. Stafford, referring to the health care system.

But another expert familiar with the study viewed the results a bit differently.

Some of the women may not have been even thinking yet about menopause, since the survey included women as young as 40, for whom menopause is typically five to 10 years away, notes Dr. William Parker, at Santa Monica-UCLA Medical Center.

"The unanswered question is, 'How many women who need to know the information now do not have it?' " says Dr. Parker.

Younger Women Will Need Info Eventually

If a woman is not at the point where she has to make a decision about hormone therapy, he says, it would not jeopardize her care if she was unaware of the study and its findings and did not have a conversation with her physician.

In his own practice, says Dr. Parker, "If a woman is, say, age 48, and comes in, says she is having occasional hot flashes but is still having periods, I tell her, 'Let's have a conversation when you need it, because this information changes so quickly.'"

Since the original WHI results were released in 2002, numerous re-analyses have been done of the study to confirm or negate the original findings, he notes.

Unless a woman needs the information immediately, reasons Dr. Parker, the office visit time would probably be better spent on other concerns or preventive health.

The study was funded by the National Heart, Lung, and Blood Institute (NHLBI) and GlaxoSmithKline Consumer Healthcare. The pharmaceutical company was interested in the data due to its black cohosh product for menopausal symptom relief, says Dr. Stafford.

Always consult your physician for more information.

Estrogen and Women

To learn more about women's health, and specifically hormone replacement therapy, the National Heart, Lung, and Blood Institute (NHLBI) launched the Women's Health Initiative (WHI) in 1991. The hormone trial had two studies: the estrogen-plus-progestin (HRT) study of women with a uterus and the estrogen-alone (ERT) study of women without a uterus.

Both studies were concluded early when the research showed that hormone replacement did not help prevent heart disease and it increased risk for some medical problems.

The WHI recommends that women follow the Food and Drug Administration (FDA) advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It states that hormone therapy should not be taken to prevent heart disease.

These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy.

Although hormone therapy is effective for the prevention of postmenopausal osteoporosis, it should only be considered for women at significant risk of osteoporosis who cannot take non-estrogen medications.

The FDA recommends that hormone therapy be used at the lowest doses for the shortest duration needed to achieve treatment goals.

Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their physicians.

The NHLBI says because the study involved healthy women, only a small number of them had either a negative or positive effect from estrogen plus progestin therapy.

The percentages describe what would happen to a whole population - not to an individual woman. In the estrogen plus progestin therapy study, the increase risk of breast cancer was less than a tenth of 1 percent each year.

When this risk is applied to a large group of women and over several years, then the number of women affected becomes a public health concern.

The most important thing a woman can do in deciding to continue hormone replacement therapy is discuss the current research with her physician and healthcare team.

Women need to be aware that taking a combined progesterone and estrogen regimen or estrogen alone is no longer recommended to prevent heart disease. A woman should discuss other alternatives of protecting the heart with her physician.

Women should discuss with their physicians the value of taking combined progesterone and estrogen replacement therapy or estrogen to prevent osteoporosis. There may be alternative treatments based on a woman's unique health profile.

Always consult your physician for more information.