Abstract
"The media attention surrounding the
publication of the initial results of WHI in 2002 led to fear and
confusion regarding
the use of hormonal therapy (HT) after menopause.
This led to a dramatic reduction in prescriptions for HT in the United
States
and around the world. Although in 2002 it was
stated that the results pertained to all women receiving HT, subsequent
studies
from the Women's Health Initiative (WHI) and others
clearly showed that younger women and those close to menopause had a
very
beneficial risk-to-benefit ratio. Indeed, the
results showed similar protective effects for coronary disease and a
reduction
in mortality that had been shown in earlier
observational studies, which had also focused on younger symptomatic
women. In
younger women, the increased number of cases of
venous thrombosis and ischemic stroke was low, rendering them “rare”
events
using World Health Organization nomenclature.
Breast cancer rates were also low and were found to be decreased with
estrogen
alone. In women receiving estrogen and progestogen
for the first time in the WHI, breast cancer rates did not increase
significantly
for 7 years. Other data suggest that other regimens
and the use of other progestogens may also be safer. It has been argued
that in the 10 years since WHI, many women have
been denied HT, including those with severe symptoms, and that this has
significantly
disadvantaged a generation of women. Some reports
have also suggested an increased rate of osteoporotic fractures since
the
WHI. Therefore, the question is posed as to whether
we have now come full circle in our understanding of the use of HT in
younger women. Although it is appropriate to treat
women with symptoms at the onset of menopause, because there is no
proven
therapy for primary prevention, in some women the
use of HT for this role may at least be entertained."
