Hormone replacement therapy or (HRT) is an excellent way to treat menopausal symptoms associated with decreased estrogen which occurs in the Peri-menopausal and Menopausal years.
Symptoms of decreased estrogen are hot flashes/night sweats, sleep disturbances and vaginal dryness. HRT can also prevent osteoporosis and osteopenia.
Many clinicians are weary about prescribing HRT or are prescribing lower doses for shorter periods of time as a result of The Women’s Health Initiative study that was done in 2002. This study was dropped after 5 ½ years after investigators found that the associated risks of combination hormone therapy outweighed the benefits. Such risks included coronary artery disease and invasive breast cancer.
As a result of this study the United States Food and Drug Administration and Health Canada assigned a “black box” warning to all medications that contain estrogen. This “black box” warning was to be present in all estrogen containing prescriptions stating the adverse effects of estrogen. Only two products of estrogen were studied in the 2002 Women’s Health Initiative Study. These products w ere Premarin and Prempro. The study made the assumption that the risks of all hormone therapy products including bioidentical and compounded hormones carry the same risk as Premarin and Prempro.
In 2005 Dietel et al. (Dietel et al; 2005 summarized the views of many investigators who have indicated that WHI study in 2002 did not qualify as a randomized placebo-controlled study. In addition, the women in the WHI 2002 study were 12-15 years past the onset of menopause. In summary, the findings of the WHI 2002 study should have been no significant risks were found for cardiovascular disease, invasive breast cancer, stroke and venous thromboembolism. When this information was released to the media it resulted in considerable confusion among patients and providers alike. This resulted in a general uneasiness about HRT and menopause. Less providers wrote prescriptions for HRT and more women suffered .
As more research has been conducted medical professionals have modified their views about the role of hormones with quality of life being strongly considered. Some reassuring news about HRT has been demonstrated in a new Women’s Health Initiative Study. In this study 17,000 postmenopausal women with intact uteruses were randomized to receive either daily conjugated estrogens plus progesterone or a placebo. An additional 11,000 women who had undergone a hysterectomy were randomized with oral estrogen alone or a placebo. These women were followed for 18 years. The results showed that neither combination hormone therapy or estrogen alone therapy did not put women at increased risk for death, cardiovascular disease and cancer. This study was published in Jama.
As more studies are conducted showing the benefits of HRT I am optimistic that more and more women will be treated for troubling menopausal symptoms and thus have a much better quality of life.