In a recent commentary on hormone replacement therapy (HRT),1 the authors began by saying that physicians have been prescribing hormones to women as a “wonder pill” without appropriate studies to fully evaluate the risks and benefits. They concluded by saying that the Women's Health Initiative (WHI) study tells us to avoid HRT as far as possible. Are the authors of the commentary not just as guilty of jumping to conclusions?
Granted, the WHI was well designed and well implemented. But what exactly does this study tell us? The WHI researchers have not stopped the arm of the study in which women who have had a hysterectomy are given estrogen only, so we might gather that this large group has not experienced an increase in heart disease, blood clots, strokes or breast cancer. This would lead us to conclude that medroxyprogesterone is the culprit, not estrogen and not necessarily the other very different progestins.
We have known for years that estrogen improves cholesterol levels2,3 and that medroxyprogesterone negates that benefit.4 The WHI has simply confirmed the negative effects of this one hormone preparation, nothing else. Hence, we should not jump to conclusions and condemn all other hormone preparations.
The risks and benefits of the other preparations remain to be painstakingly researched. Our menopausal patients expect nothing less.
Lianne Lacroix Glenmore Medical Clinic Kelowna, BC
Footnotes
Competing interests: Dr. Lacroix receives speaker fees from an annual public speech on menopause sponsored by a pharmaceutical company. In making these presentations, she sponsors no products and follows the guidelines of the Society of Obstetricians and Gynaecologists of Canada.
References
- 1.Yusuf S, Anand S. Hormone replacement therapy: a time for pause. CMAJ 2002;167(4):357-9. [PMC free article] [PubMed]
- 2.Reid RL, Jolly E, Moreau M, McSherry J. Hormone replacement therapy and menopause: a clinical handbook. Ottawa: Society of Obstetricians and Gynaecologists of Canada; 1996.
- 3.Turek MA, Derzko C. Canadian Consensus Conference on Menopause and Osteoporosis. Part 2: Hormone replacement therapy and cardiovascular disease. Ottawa: Society of Obstetricians and Gynaecologists of Canada. J Obstet Gynaecol Can 2001;23:967-72.
- 4.Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA 1995;273:199-208. [PubMed]