Estrogen Alone Has Little Benefit, Some Harm
No Effect on Breast Cancer, Heart Disease, but Increases Stroke Risk
No Change in Treatment Needed for Women on HT continued...
"One of the messages that needs to be understood is this is one form of estrogen and one group of women. It may or may not apply to all estrogens and all women," Phillips says. "These women had an average age of 63 when they started the study. That is somewhat older than the age at which estrogens usually are started. When the data becomes available, we will have to look closely to see how to get the best translation for an individual patient."
Indeed, the women enrolled in the WHI trial are not like most women who begin menopausal hormone therapy these days. Study participants were not taking HT to fight serious symptoms of menopause, but to try to improve their long-term health. That didn't work, but there's still broad agreement that hormone therapy is the most effective treatment for women with severe menopausal symptoms.
"The lesson of WHI is that HT should not be given for quantity of life. It has always been intended for those who need help with the quality of their lives," Robert Rebar, MD, executive director of the American Society for Reproductive Medicine, tells WebMD.
The NIH advises women to follow FDA recommendations on hormone therapy. That advice: To discuss the risks and benefits of menopausal hormone therapy with their doctors. Hormone therapy is the only truly effective treatment for severe menopausal symptoms. But because of the risks, the FDA and drugmakers recommend using it at the lowest effective dose for the shortest possible time.
Indeed, Wyeth's Premarin and Prempro -- the estrogen and estrogen plus progestin drugs used in the WHI study -- are now sold at doses half as strong as those used in the trial. Victoria Kusiak, MD, Wyeth's North American medical director, says patients should try the lowest dose first. While these lower doses do help relieve hot flashes, the risks are largely unknown. Wyeth is a WebMD sponsor.
WHI Results Reassuring
It's no big surprise that estrogen-only treatment slightly increases a woman's risk of stroke. The same risk was seen in the estrogen plus progestin arm of the study. What's reassuring is that estrogen-only treatment does not increase a woman's breast cancer or heart risk.
"It is good news that estrogen didn't increase women's risks of heart disease and breast cancer," Rebar says. "The risk of stroke is known, and modest. As with any medicine, a patient must weigh the risks. For symptomatic women, estrogen remains a viable choice."