New Evidence about Hormone Replacement Therapy: Turning the Tide in the Menopause Wars

A media frenzy erupted recently when the news broke that an American federal study of hormone replacement therapy (HRT) was halted midway because study participants were at a significantly increased risk for breast cancer, heart attack, stroke, and blood clots. The Women's Health Initiative (WHI), funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, did something rare in the scientific world: They stopped their clinical trial for HRT 3 years before the scheduled study conclusion because their preliminary findings demonstrated that the serious health risks associated with the long-term use of combined estrogen plus progestin greatly outweigh any health benefits (Women's Health Initiative, 2002; Writing Group, 2002). The study results were no surprise to the many women's health organizations who have been following the questionable methods used to promote the prescription of HRT to healthy midlife women (National Women's Health Network 2002; Women's Health Clinic 2002). Hormone therapy (HT) or hormone replacement therapy (HRT) refers to the use of combined estrogen and progestin, often prescribed to supplement the declining levels of these hormones that occur during menopause. Short-term use of HRT has been documented in a variety of studies as a useful treatment for alleviating the temporary symptoms associated with the onset of menopause, such as hot flashes, night sweats, and vaginal dryness. However, long-term use of HRT (more than 5 years), and the practice of prescribing HRT to healthy women-those not experiencing severe menopausal symptoms-is another matter. The WHI results are only the latest in a long series of studies demonstrating that long-term use of HRT should be considered only with extreme caution. Yet for more than a decade, healthy women have been advised by medical practitioners and medical advisory bodies to take HRT when they reach menopause as a means to prevent heart disease and osteoporosis. Some of the more dubious pharmaceutical marketing and advertisements for HRT insinuate even more sensationalistic claims, leading women to believe that HRT reduces the signs of aging, cures depression and incontinence, prevents the onset of Alzheimer's disease, and much more. In other words, HRT has been touted as the miraculous "wonder drug" for midlife women. But somehow the science got lost along the way. The Medicalization of Menopause The last decade has seen an accumulated medicalization of menopause, from a natural stage of a woman's life to an "ailment" or "disease" requiring a pharmaceutical "fix." Not incidentally, this occurred at precisely the moment when millions of baby-boom women across North America began entering midlife. The direct beneficiaries of the HRT craze have been the pharmaceutical companies who have turned HRT into a multibillion-dollar industry. Wyeth, the makers of Premarin, the largest selling HRT formula in the United States, sold U.S.$2.07 billion in Premarin prescriptions last year alone, making it the company's best-selling drug. But the losers in the HRT craze have been precisely those midlife women who were supposed to benefit from the effects identified in the health claims associated with HRT. The latest WHI study results are clear: The relative risks for long-term HRT (combined estrogen plus progestin for more than 5 years) constitutes a whopping 41% increased risk for strokes; 29% increased risk for heart attacks; a doubled risk for blood clots; a 22% increased risk for cardiovascular disease; and a 26% increased risk for breast cancer (Women's Health Initiative, 2002; Writing Group, 2002). Some media reports have downplayed the relative risks by citing the actual number of women at increased risk, and at a glance, these numbers do appear meager: According to the WHI study, only 8 more women in 10,000 will have breast cancer; 7 more, a heart attack; 8 more, a stroke; and 18, blood clots, all because of long-term HRT use. …