Reevaluating Hormone Replacement Therapy

Researchers have gained valuable insights since Women's Health Initiative was halted in 2002.

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, July 11 (HealthDay News) -- Five years after the results of the Women's Health Initiative sounded the supposed death knell for hormone replacement therapy, experts gathered Wednesday to reassess those results and discuss the fine-tuning and evaluation that has taken place since.

"The science has evolved substantially in the past five years," Dr. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston, said at a press conference sponsored by the Society for Women's Health Research. "There's been mounting evidence that a woman's age and amount of time since onset of menopause may influence the effect of hormone therapy."

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The Society for Women's Health Research is a nonprofit organization but has received funds from companies such as Amgen, Cytyc, Eli Lilly, Ethicon and Wyeth.

The original Women's Health Initiative (WHI) was halted when U.S. researchers found an increased risk of adverse events which, depending on whether the woman was taking estrogen alone or estrogen plus progestin, included heart attack, stroke, breast cancer and blood clots. Manson was one of the principal investigators on the WHI trial.

The average age of women enrolled in the WHI was 63, or about 12 years past menopause.

And the trial was designed not to look at how well hormone therapy combated menopausal symptoms such as hot flashes, but whether it could play a role in chronic disease prevention.

"The WHI was designed to evaluate the balance of benefits and risks of hormone therapy in generally healthy postmenopausal women when used for chronic disease prevention," Manson said. "At the time WHI was started in the early 1990s, it was becoming increasingly common in clinical practice to use hormone therapy in older women who were at high risk of cardiovascular disease, or who already had a diagnosis of cardiovascular disease, in order to prevent future cardiovascular events."

Since then, it has become increasingly clear that hormone therapy has different benefits and risks, depending on the age of the woman.