Menopause Health Center

HRT: Revisiting the Hormone Decision

It was the summer of 2002 when the news about hormone replacement therapy (HRT) shook us to the core. 

In what felt like a bomb dropped on all womankind, the U.S. federal government halted the hormone trial of the Women's Health Initiative early – a study designed to evaluate the risks and benefits of hormone replacement therapy on disease prevention. 

The reason: Not only had HRT failed to be the protective fountain of youth doctors and women had long since believed, evidence was mounting that taking it may be harmful.

"It was like an abrupt hit in the solar plexus -- with a message that was loud and clear: If you value your life, don't even be in the same room as a bottle of hormones," says Steven Goldstein, MD, professor of medicine at NYU Medical Center and board member of the North American Menopause Society.

Increased risks of breast cancer, heart disease, stroke, and blood clots were just some of the problems researchers documented in women using HRT.

And while the study also found hormone therapy reduced the risk of fractures and possibly colon cancer, on a cultural as well as a medical level that didn't seem to matter.  The moment the estrogen hit the fan, women began rejecting hormone use in droves.

At the time, certainly the WHI findings seemed to be the final word on HRT.  But fast-forward five years and we find the picture of hormone replacement therapy is changing yet again.

"We have had time and resources to carefully tease out the data and perhaps collect a little bit more, and what we have found at least reassures us that for some women who have menopausal symptoms, HRT is not the ominous prescription we thought when the data first came out," says Cynthia Stuenkel, MD, professor of medicine at the University of California at San Diego.

Clearly, at least some of the problems with HRT brought to light in 2002 are still in place today.

The WISDOM (Women's International Study of Long Duration Oestrogen after Menopause) study recently published in the BMJ duplicated many of the same findings detailed by the WHI, particularly concerning the increased risk of heart disease in older women who began or restarted hormone therapy long after menopause.

At the same time, however, in the five years since the WHI, another, equally important fact has emerged: The seemingly huge difference a few birthday candles can make when it comes to the impact of HRT on a woman's heart.

Why Age Matters

Because the WHI study included women from ages 50 to 79, the initial results were a combined tabulation of all age groups together.  But Goldstein says that when data was re-analyzed to focus on the youngest members alone, an entirely different risk-to-benefit ratio of HRT began to emerge.